Available online 25 November 2023, 151548

Author links open overlay panel, , AbstractObjectives

Our focus within this review is to summarize key advances and new therapeutic approaches within advanced triple-negative breast cancer. In addition, we highlight the importance of multidisciplinary management, discussing key issues for patients and importance of the supportive role that specialist nurses provide.

Data Sources

Peer-reviewed literature, clinical practice guidelines, clinical trial, and government websites.

Conclusion

Triple-negative breast cancer is a highly heterogeneous subtype of breast cancer, often associated with a less favorable prognosis compared to other types. Significant advances in our understanding of specific mutations and signaling pathways within this subtype, coupled with expanding therapeutic options, has broadened the treatment landscape considerably. While chemotherapy traditionally formed the mainstay of treatment, new therapeutics such as immunotherapy, targeted agents, and antibody-drug conjugates in first-line and subsequent-line settings are now available. It is essential for all those who care for this patient group to be up-to-date on current practice and emerging treatments, so patients receive the support they need and deserve.

Implications for Nursing Practice

Nurses need to become familiar with new systemic anticancer therapies within advanced triple-negative breast cancer to provide patients with adequate information about new treatment options and support with potential treatment-associated toxicities. It is important for nurses to be able to recognise key issues facing patients with a diagnosis of advanced triple-negative breast cancer, to gain a deeper understanding of both the physical and psychosocial support required, signposting or referring patients to additional support services if needed.

Section snippetsTriple-Negative Breast Cancer

Triple-negative breast cancer (TNBC), defined by the absence of expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), accounts for approximately 15–20% of all breast cancers.1 Compared stage for stage to hormone receptor–positive disease, TNBC carries a worse prognosis with higher recurrence rates and worse mortality. For advanced TNBC (stage 4 or unresectable stage 3), the average overall survival is just 12–18 months.2

Molecular Subtypes of TNBC

Considerable research has been done to help classify TNBCs into distinct clinical and molecular subtypes with the purpose that this could help guide treatment decisions. As such, various molecular classification systems have been developed and adapted over the past decade.

In 2011, Lehmann et al performed gene expression profiling on 587 triple-negative tumor samples to classify TNBCs into six distinct subtypes—two basal-like (BL1 and BL2) subtypes that involve DNA damage response and cell cycle

Future Directions in Research

The last few years have seen a move to targeted treatments and biomarker driven strategies for TNBC, however the significant tumour heterogeneity and complex molecular pathways involved continue to make this cancer type challenging. Further translational research into the biology of the disease and mechanisms of drug resistance will define future clinical trials involving potential combinations of immunotherapy and targeted treatments. As we gain more access to patient-specific molecular

Key Issues for Patients and the Supportive Role of the Multidisciplinary Team

TNBC has perceived negative connotations for patients from first diagnosis, perhaps not without substance, given the poorer outcome compared with other subtypes of breast cancer. This negativity presents challenges for patients and those supporting them, particularly when they are diagnosed with advanced disease. While acknowledging this, it is imperative that we maintain hope and a positive approach, to ensure we enable patients to lead a good quality of life, whatever longevity, particularly

Conclusion

Advances in therapeutic options for patients with advanced TNBC have great potential to improve outcomes in patients with this disease. However, the challenges these new and more focused treatments pose impact the support required. It is important for clinicians, specialist nurses, and other health care professions who support this patient group to be up-to-date on current practice, new treatments, and future possibilities to be able to ensure that patients receive the care they need and

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

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