Targeting low-risk triple-negative breast cancer: a review on de-escalation strategies for a new era.

Filomena Marino Carvalho
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Abstract

Triple-negative breast cancer (TNBC) is a subtype of breast cancer lacking estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. Comprising 15-20% of breast cancers, TNBC is typically high-grade, affects younger women, and has a poor prognosis. However, TNBC is heterogeneous, encompassing different molecular subtypes and histological types with distinct molecular drivers, prognoses, and treatment responses. Among these, a subset of low-risk diseases associated with a lower risk of recurrence led to the exploration of de-escalation strategies. This review presents the clinicopathological characteristics of special TNBC with a better prognosis that could be spared from aggressive systemic treatment. We searched the PubMed database for articles that could support treatment de-escalation using the keywords "early-stage", "TNBC", and "low-risk". This article addresses four subgroups of low-risk TNBC: special histological types, tumors with high tumor-infiltrating lymphocytes (TILs), low Ki-67 levels, and early-stage tumors that achieved pathological complete response (pCR). The discussion explores the optimization of treatment options ranging from the omission of any systemic treatment to anthracycline-free possibilities and/or immunotherapies. Identifying these tumors can help personalize treatment, reduce costs and unnecessary toxicity, and contribute to a better quality of life for patients with favorable prognoses. Further studies should explore reliable biomarkers to identify these low-risk diseases precisely.

针对低风险三阴性乳腺癌:新时代的降级策略综述。
三阴性乳腺癌(TNBC)是一种缺乏雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2 (HER2)表达的乳腺癌亚型。TNBC占乳腺癌的15-20%,通常为高级别,影响年轻女性,预后较差。然而,TNBC是异质性的,包括不同的分子亚型和组织学类型,具有不同的分子驱动因素、预后和治疗反应。其中,与复发风险较低相关的低风险疾病子集导致探索降低升级策略。本文综述了特殊TNBC的临床病理特征,预后较好,可以避免积极的全身治疗。我们用关键词“早期”、“TNBC”和“低风险”在PubMed数据库中搜索可以支持治疗降级的文章。本文讨论了四种低风险TNBC亚组:特殊组织学类型,肿瘤浸润淋巴细胞(til)高,Ki-67水平低,以及实现病理完全缓解(pCR)的早期肿瘤。讨论探讨了治疗方案的优化,从遗漏任何全身治疗到无蒽环类药物和/或免疫治疗的可能性。识别这些肿瘤有助于个性化治疗,降低成本和不必要的毒性,并有助于改善预后良好的患者的生活质量。进一步的研究应该探索可靠的生物标志物来精确识别这些低风险疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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