# Triple-negative breast cancer (TNBC)

Source: https://onco.cc/cancers/tnbc/  
OnCo record `tnbc` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A breast cancer that lacks the three receptors (oestrogen, progesterone, HER2) that other breast cancers can be treated through. It was the hardest subtype for decades; since 2020 immunotherapy and ADCs have changed that.

## Summary

TNBC is defined by what it lacks: ER <1%, PR <1%, HER2 0-1+ (or 2+/ISH-negative). It is biologically heterogeneous (basal-like 1 and 2, mesenchymal, luminal androgen receptor, immunomodulatory subtypes), nearly always TP53-mutant, frequently HRD-positive (11 to 17% germline BRCA1/2 by cohort), and has the highest TROP2 expression and the most immune infiltration of any breast subtype. Relapses cluster in the first three years and favour visceral and brain metastases.

The standard of care changed three times in six years. KEYNOTE-522 (2020-21) made pembrolizumab plus carboplatin-containing chemotherapy before surgery, continued after, the standard for stage II-III disease, with a 4.9-point overall survival gain at five years (86.6% against 81.7%). OlympiA (2021) added adjuvant olaparib for germline BRCA carriers with residual disease. In metastatic disease, pembrolizumab-chemotherapy (CPS ≥10) was joined by the TROP2 ADCs: sacituzumab govitecan (ASCENT, second line 2020; first-line ASCENT-03/04 2026) and datopotamab deruxtecan (TROPION-Breast02, first-line PD-1-ineligible, 2026, with an overall survival benefit), while T-DXd covers the roughly one third of TNBC that is HER2-low (24 to 37% by cohort). The EGFR×HER3 bispecific ADC iza-bren posted the first positive phase 3 for a bispecific ADC in pretreated TNBC in February 2026.

What remains unsolved: residual disease after KEYNOTE-522 (RCB II-III) still carries ~40-50% relapse risk; ADC sequencing (TOP1-payload cross-resistance) is unstudied; PD-L1-negative early disease has immunotherapy proven only in KEYNOTE-522's unselected population; brain metastases; and the biology of the mesenchymal/claudin-low subtype resists every class. The most promising directions are ADC + IO first line, de-escalation guided by TILs and pCR, ctDNA-guided escalation, TROP2 PET selection, next-generation ADCs with non-TOP1 or dual payloads, and personalised vaccines in the adjuvant setting.

How common it is, world and United States. No registry publishes a world count of triple-negative disease; the share has to be applied to breast cancer as a whole. The IARC breast fact sheet, served today with the GLOBOCAN 2024 estimates, gives 2,434,087 new breast cancers a year (the second commonest cancer, age-standardised rate 47.8 per 100,000) and 693,660 deaths (fourth, 12.9 per 100,000), with 45.1 percent of cases in Asia, 22.3 percent in Europe, 13.2 percent in Northern America, 9.3 percent in Africa and 9.0 percent in Latin America and the Caribbean. The triple-negative share in registries with receptor data runs from 8.4 percent of 1,151,724 US cases in 2010 to 2014 (Scott 2019) through 10.8 percent of US cases with a known subtype in SEER 21, 2019 to 2023 (the SEER subtype fact sheet), 12.2 percent of cases with known status in 2010 (Howlader 2014) and 12 percent in 2012 to 2016 (Howard and Olopade 2021), to around 15 percent on the Cancer Research UK patient page and 17 percent of 15,204 women treated at NCCN centres in 2000 to 2006 (Lin 2012). Applied to 2.4 million, a share of 10 to 15 percent would be about 240,000 to 370,000 people a year; that is arithmetic on the figures above, not a published count. In the United States the age-adjusted rate of hormone receptor-negative, HER2-negative breast cancer is 14.3 per 100,000 women a year against 132.5 for all breast cancer (SEER 21, 2019 to 2023), and 321,910 new female breast cancers of all subtypes are projected for 2026.

Who gets it. Age: triple-negative tumours are diagnosed younger than hormone receptor-positive tumours. Women under 40 had 1.53 times the odds of the triple-negative phenotype in the California registry (Bauer 2007) and 1.95 times the odds relative to women aged 50 to 64 in US Cancer Statistics (Scott 2019); Howlader found triple-negative patients 10 to 30 percent less likely to be diagnosed at older ages and 6.4 to 20 times more likely to present with high-grade disease; Cancer Research UK says the type develops more often in women under 40. Ethnicity: in SEER 21 (2019 to 2023) the rate of hormone receptor-negative, HER2-negative disease is 25.7 per 100,000 in non-Hispanic Black women against 13.0 in non-Hispanic White, 12.5 in Hispanic, 11.4 in American Indian and Alaska Native and 10.5 in Asian and Pacific Islander women, roughly a two-fold difference; non-Hispanic Black women had 2.27 times the odds of a triple-negative diagnosis in 2010 to 2014 (Scott 2019); the basal-like subtype was found in 39 percent of premenopausal African American women against 16 percent of non-African American women in the Carolina Breast Cancer Study (Carey 2006); and in 507 women in Nigeria and Senegal, triple-negative disease (basal-like 27 percent plus unclassified 28 percent) predominated, with a mean age of 44.8 (Huo 2009). In the UK, the POSH cohort of women diagnosed at 40 or under found triple-negative tumours in 26.1 percent of Black against 18.6 percent of White patients (Copson 2014), and an analysis of 116,500 women in England (2013 to 2018) found greater adjusted odds of ER-negative, high-grade and high-stage tumours in ethnic minority women, most marked in Black African and Black Caribbean women (Gathani 2021). Even after adjustment for stage, treatment delay and socioeconomic factors, African American women with triple-negative disease remain nearly twice as likely to die of it (Howard and Olopade 2021). Inherited risk: 57.1 percent of breast cancers in BRCA1 carriers were triple-negative against 23.3 percent in BRCA2 carriers and 13.8 percent in non-carriers (Atchley 2008); in 6,893 carriers the triple-negative share fell with age at diagnosis in BRCA1 and rose in BRCA2 carriers, and medullary tumours were BRCA1-related (Mavaddat 2012). Looked at from the other side, 14.6 percent of 1,824 triple-negative patients unselected for family history carried a deleterious mutation in one of 17 genes, 8.5 percent BRCA1, 2.7 percent BRCA2 and 1.2 percent PALB2 (Couch 2015); a prospective US registry found 15.4 percent with BRCA1 or BRCA2 mutations, 27.6 percent among those diagnosed at 50 or under, 11.4 percent at 51 to 60 and 4.9 percent at 61 or over (Sharma 2014); and 12 percent of 2,733 UK women with breast cancer at 40 or under carried a BRCA mutation (Copson 2018). Cancer Research UK puts the lifetime breast cancer risk of a BRCA1 or BRCA2 carrier at 45 to 65 percent by age 70, with about 1 in 450 women carrying a mutation; PALB2 carries a relative risk of 7.18 and a 53 percent risk to age 80 (Yang 2020).

United Kingdom (Cancer Research UK, drawing on the four national registries). Breast cancer is the commonest cancer, with 59,413 new cases a year (2019 and 2021 to 2022), about 59,000 in females and 420 in males, 15 percent of all cancers; a quarter are diagnosed at 75 or over; incidence rates have risen 20 percent since the early 1990s and are projected to fall 1 percent by 2038 to 2040 while the count rises to about 70,300 a year; incidence rates are lower in the Asian and Black ethnic groups than the White group in England (2013 to 2017), which sits beside the higher triple-negative share in Black women noted above. There are about 11,200 deaths a year (2022 to 2024), the fourth commonest cause of cancer death and the second in women; mortality rates have fallen 46 percent since the early 1970s. In England in 2022, 85 percent of cases with a known stage were stage I or II; in 2019, 53 percent were diagnosed through an urgent suspected cancer referral, 32 percent through screening and 4 percent after an emergency presentation. About 23 percent of UK breast cancers are judged preventable, 8 percent attributed to alcohol and 1 percent to ionising radiation. Cancer Research UK does not publish a separate UK incidence count for triple-negative disease; the around 15 percent share on its patient page, and the 20 percent share in the young-onset POSH cohort (558 of 2,733), are the UK figures found for this record.

Risk factors that separate triple-negative from other breast cancers. Reproduction runs the other way from hormone receptor-positive disease: in 23,353 cases and 71,072 controls pooled across 31 studies, parous women had a lower risk of every luminal and HER2-enriched-like subtype but a higher risk of triple-negative disease immediately after a birth (odds ratio 3.12 for multiparous women right after their last birth), attenuating over decades (Jung 2022); in African American women parity raised triple-negative risk (odds ratio 1.37) while breastfeeding lowered ER-negative risk (0.81), and ER-negative risk rose with each birth in women who had not breastfed (1.68 for four or more births) (Palmer 2014). Cancer Research UK's summary that triple-negative disease is not associated with parity, from an older meta-analysis, is recorded beside these newer pooled analyses. Obesity: triple-negative cases were more often obese than hormone receptor-positive cases (odds ratio 1.20 case-case, 1.24 case-control), a signal confined to premenopausal women (1.43) in an 11-study meta-analysis (Pierobon 2013), and 1.89 in an Atlanta case series (Trivers 2009); Cancer Research UK notes the postmenopausal body-mass effect is largely limited to ER- and PR-positive tumours (adult weight gain raised ER- and PR-negative risk by 34 percent against 133 percent for positive tumours). Age at first birth and at menarche, and oral contraceptive or HRT use, are associated mainly with hormone receptor-positive tumours (CRUK risk page). A first-degree relative with breast cancer doubles breast cancer risk of any type, and the germline factors above (BRCA1 above all, then PALB2 and BRCA2) are the strongest known triple-negative risk factors. What is shared with all breast cancer: alcohol (8 percent of UK cases), ionising radiation (1 percent) and breast density (3 to 5 times the risk in the most dense breasts).

How it presents. Symptoms are those of any breast cancer: a lump or thickening in the breast or armpit, a change in size, shape or feel, skin puckering, dimpling, a rash or redness, fluid from the nipple, or a nipple that turns in (Cancer Research UK triple-negative and symptoms pages). What differs is the route and the tempo. Triple-negative tumours are less often found by a screening mammogram (29 percent against 48 percent of hormone receptor-positive, HER2-negative tumours in NCCN centres) and present with a higher tumour category but are less likely to involve the lymph nodes (Lin 2012); they are over-represented among interval cancers, which appear between screens and carry worse prognostic features than screen-detected cancers (Houssami 2017); and they are more often high grade (Howlader 2014). Relapse is early: in 1,601 Toronto patients the triple-negative group had 2.6 times the hazard of distant recurrence and 3.2 times the hazard of death within five years but not afterwards, with the risk of distant recurrence peaking at about three years and falling rapidly (Dent 2007); recurrence and death rates were higher only in the first three years in the MD Anderson neoadjuvant series, which also found more visceral and fewer bone relapses (Liedtke 2008); and in 116 patients with metastatic disease treated in 2000 to 2006, 46 percent developed brain metastases before death and median survival from the metastatic diagnosis was 13.3 months (Lin 2008), a figure that the later trials in the treatment rows have moved. NICE NG12 (1.4) asks GPs to refer on the suspected cancer pathway anyone aged 30 or over with an unexplained breast lump, anyone 50 or over with discharge, retraction or other change in one nipple, and to consider it for skin changes or an unexplained axillary lump at 30 or over.

How it is diagnosed. In the UK the GP refers to a one-stop breast clinic for triple assessment: examination, mammogram, ultrasound and a needle core (or vacuum-assisted) biopsy, with axillary ultrasound and needle biopsy of any abnormal node (Cancer Research UK tests page). NICE NG101 (1.3.1 to 1.3.4) requires ER, PR and HER2 status to be assessed simultaneously on every invasive breast cancer at the initial histopathological diagnosis, by standardised, quality-assured immunohistochemistry reported quantitatively, and recorded at the preoperative and postoperative multidisciplinary meetings. Triple-negative is then a laboratory definition: ER negative when fewer than 1 percent of tumour nuclei stain, PR likewise, with 1 to 10 percent reported as a new ER Low Positive category on which endocrine benefit is uncertain (ASCO/CAP 2020, Allison); HER2 negative when immunohistochemistry is 0 or 1+, or 2+ with no amplification on in situ hybridisation (ASCO/CAP 2018, Wolff). The 2023 ASCO-CAP update kept those categories but added a reporting comment because the difference between HER2 0 and 1+ now decides eligibility for trastuzumab deruxtecan (Wolff 2023). NG101 defines triple-negative simply as ER, PR and HER2 each scored negative under local multidisciplinary team rules. Where the receptors are low rather than absent the behaviour is the same: ER 1 to 10 percent tumours matched ER-negative tumours for germline BRCA prevalence, response and survival in a US registry (Yoder 2022) and in an Italian series (Dieci 2021), and Sweden treats ER 1 to 9 percent HER2-negative tumours as triple-negative, with 9.9 percent of 5,655 such cancers in 2008 to 2020 falling in that band (Acs 2024). Breast MRI is not routine before surgery but is offered when the extent of disease is unclear, when breast density defeats mammography, or to size an invasive lobular cancer (NG101 1.2). Staging tests beyond the breast and axilla, where the stage or symptoms warrant, are CT, bone scan, liver ultrasound or PET-CT, and blood tests including CA 15-3 which cannot diagnose or direct treatment on its own (Cancer Research UK tests page). NG101 (1.3.6) adds one test that applies to this subtype alone: offer germline BRCA1 and BRCA2 testing to women under 50 with triple-negative breast cancer, including those with no family history.

What the pathologist sees. Most triple-negative cancers are invasive carcinomas of no special type (the term the 2019 WHO classification, 5th edition, uses for what was called ductal carcinoma) of grade 3, with a high proliferation index: the Swedish cohort's median Ki-67 was 63 percent in ER-zero and 60 percent in ER-low tumours, and 80.8 percent of ER-zero tumours were grade III (Acs 2024). By gene expression, 78.6 percent of triple-negative tumours are basal-like and 21.4 percent belong to other intrinsic subtypes, while 31.5 percent of basal-like tumours are not triple-negative (Prat 2013); basal-like tumours share many molecular features with high-grade serous ovarian cancer, and TP53 is the mutation that recurs across them (TCGA 2012). Within the triple-negative group, Lehmann's 2011 analysis of 587 cases found six expression subtypes (basal-like 1 and 2, immunomodulatory, mesenchymal, mesenchymal stem-like and luminal androgen receptor), refined in 2016 to four tumour-intrinsic subtypes once the immunomodulatory and stem-like signals were traced to infiltrating lymphocytes and stroma; Burstein's four (luminal androgen receptor, mesenchymal, basal-like immunosuppressed and basal-like immune-activated) overlap them. Each has a page linked from this record. The WHO classification also names special histological types that are usually triple-negative: metaplastic carcinoma (70.3 percent triple-negative in 2,451 US cases, Ong 2018), carcinoma with medullary pattern (no longer a separate type in the 5th edition, Thomas 2023; Cserni 2020), adenoid cystic carcinoma (95 percent localised at diagnosis, 15-year relative survival 91.4 percent, Ghabach 2010), apocrine carcinoma (ER and PR negative, androgen receptor positive, Vranic 2013) and secretory carcinoma (ETV6-NTRK3 fusion in 92 percent, Tognon 2002). Rare subtypes together are 5 to 10 percent of triple-negative cancers (Thomas 2023), and the European Working Group for Breast Screening Pathology concludes that patients with the indolent pure forms (classical adenoid cystic, low-grade adenosquamous, fibromatosis-like metaplastic, secretory, acinic cell, tall cell with reversed polarity) are unlikely to benefit from chemotherapy (Cserni 2021). Stromal tumour-infiltrating lymphocytes are scored on the biopsy, and PD-L1 combined positive score is tested when metastatic treatment is planned (the glossary terms carry the thresholds).

How it is staged. The TNM 8th edition (2017) is the usual system in the UK, and Cancer Research UK sets it out in plain words. T1 is 2 cm or less (T1mi 0.1 cm or less, T1a to 0.5 cm, T1b to 1 cm, T1c to 2 cm), T2 over 2 to 5 cm, T3 over 5 cm, T4 into the chest wall (a), skin (b), both (c) or inflammatory carcinoma (d). Nodes are staged clinically (cN) before any treatment and pathologically (pN) from the sentinel node or clearance: pN1 one to three axillary nodes (pN1mi micrometastases 0.2 to 2 mm), pN2 four to nine, pN3 ten or more or infraclavicular, or axillary plus internal mammary, or supraclavicular nodes. Stage 1A is T1 N0; 1B adds micrometastases; 2A is T0 to T1 N1 or T2 N0; 2B is T2 N1 or T3 N0; 3A is N2 with T0 to T3 or T3 N1; 3B is T4 with N0 to N2; 3C is any N3; stage 4 is any M1. The American Joint Committee on Cancer's 8th edition kept this anatomic stage but added a prognostic stage that folds grade, ER, PR and HER2 status (and, for some hormone receptor-positive tumours, a low Oncotype DX score) into the stage group (Giuliano 2017); in a 3,327-patient MD Anderson cohort the prognostic stage moved 29.5 percent of patients up and 28.1 percent down, and predicted disease-specific survival better than the anatomic stage (C index 0.84 against 0.74), with the same result in 54,727 Californian patients (Weiss 2018). Because grade 3 and receptor negativity count against a tumour, a triple-negative cancer generally carries a higher prognostic than anatomic stage; the UK pathway pages quote the anatomic stage. When chemotherapy is given before surgery, as it is for most stage II and III triple-negative disease, the response at surgery (pathological complete response or residual cancer burden) becomes the stronger prognostic marker (Cortazar 2014; Symmans 2017; the glossary terms).

Screening and prevention. There is no screening test for triple-negative disease as such. The NHS Breast Screening Programme invites everyone registered as female from age 50 (first invitation between 50 and 53) every three years until their 71st birthday, and women 71 or over can ask for screening (NHS). Because triple-negative tumours arrive younger and grow between rounds, a smaller share is screen-detected (Lin 2012; Houssami 2017), which is one reason the family history pathway matters here. NICE CG164 sets the UK rules: GPs refer to a specialist breast or genetics clinic on defined family patterns, and clinicians should seek genetics advice for families containing triple-negative breast cancer under 40, Jewish ancestry, sarcoma under 45 or glioma; genetic testing is offered when the combined BRCA1 and BRCA2 carrier probability is 10 percent or more (calculated with CanRisk, formerly BOADICEA, or the Manchester score); known BRCA1 or BRCA2 carriers are offered annual MRI from 30 to 49 and annual mammography from 40 to 69, TP53 carriers MRI from 20, and MRI is not offered to carriers aged 50 to 69 unless the breasts are dense. In the UK MARIBS study of 649 women at high familial risk, MRI sensitivity was 77 percent against 40 percent for mammography, 92 against 23 percent in BRCA1 carriers (Leach 2005). Risk-reducing surgery: bilateral mastectomy cut breast cancer risk by about 90 percent in BRCA1 and BRCA2 carriers in PROSE (1.9 percent against 48.7 percent over a mean 6.4 years; Rebbeck 2004) and pooled relative risk 0.114 in a 15-study meta-analysis, with contralateral mastectomy 0.072 and salpingo-oophorectomy 0.552 for breast cancer overall (Li 2016), though a prospective study of 3,722 carriers found oophorectomy did not lower breast cancer risk in BRCA1 carriers (hazard ratio 0.96) (Kotsopoulos 2017). CG164 restricts risk-reducing mastectomy to a small proportion of women from high-risk families, managed by a multidisciplinary team with genetic counselling, verified family history and reconstruction options discussed. Chemoprevention has a gap that matters for this subtype: NICE offers tamoxifen (premenopausal) or anastrozole (postmenopausal) for five years to women at high risk, and considers them at moderate risk, but tamoxifen had no effect on invasive ER-negative breast cancer in IBIS-I (hazard ratio 1.05 over 16 years; Cuzick 2015) or NSABP P-1 (Fisher 1998), and anastrozole's 49 percent reduction in IBIS-II was in ER-positive disease (Cuzick 2020); Cancer Research UK says the trial evidence is unclear for women with gene changes. One observational signal runs the other way: tamoxifen after a first breast cancer was associated with a lower contralateral breast cancer risk in BRCA1 (hazard ratio 0.38) and BRCA2 (0.33) carriers regardless of the first tumour's ER status (Phillips 2013). Breastfeeding is the modifiable factor with a specific ER-negative signal (Palmer 2014), and keeping a healthy weight and being physically active are the general measures Cancer Research UK names.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Tags: spike; breast
- Group: breast
- Burden: About 10 to 15 percent of breast cancers: 10.8 percent of US cases with a known subtype (SEER 21, 2019 to 2023) and around 15 percent on Cancer Research UK's patient page, against 2.43 million breast cancers a year worldwide (GLOBOCAN 2024). Diagnosed younger, about twice as often in Black women (25.7 against 13.0 per 100,000 in the United States) and in most breast cancers arising in BRCA1 carriers.
- Subtypes: Basal-like 1 (BL1, DDR-deficient, platinum/PARP-sensitive); Basal-like 2 (BL2, growth-factor signalling); Mesenchymal / claudin-low (EMT, stem-like, chemoresistant); Luminal androgen receptor (LAR, AR+, PIK3CA-mutant); Immunomodulatory (high TILs, IO-responsive); HER2-low TNBC (~35%, eligible for T-DXd); Mesenchymal stem-like (MSL, 2011; traced to stromal cells and folded into the mesenchymal subtype in 2016); Metaplastic carcinoma (squamous, spindle cell, matrix-producing, fibromatosis-like, low-grade adenosquamous; about 70 percent triple-negative); Carcinoma with medullary pattern (a pattern of invasive carcinoma of no special type in the 2019 WHO classification, formerly medullary carcinoma; BRCA1-related); Adenoid cystic carcinoma of the breast (MYB-NFIB fusion; triple-negative with an excellent outlook); Apocrine carcinoma (ER and PR negative, androgen receptor positive; HER2 or EGFR expressed); Secretory carcinoma (ETV6-NTRK3 fusion; indolent, NTRK inhibitors when advanced); BRCA-associated triple-negative breast cancer (germline BRCA1 above all; PARP inhibitor and surgical decisions); ER-low (1 to 10 percent) HER2-negative carcinoma, treated as triple-negative in practice and in Sweden by definition
- Biomarkers: PD-L1 (22C3 CPS ≥10 for metastatic pembrolizumab); Germline BRCA1/2 and PALB2 (PARP inhibitors, surgery choices); HRD score; TILs (prognostic; de-escalation trials); HER2-low status (T-DXd eligibility); TROP2 (not required for TROP2 ADCs; PET tracers in development); Ki-67, grade; ctDNA/MRD (Signatera, investigational); AR (LAR subtype trials); TMB / MSI (rare, tumour-agnostic IO); ER and PR by immunohistochemistry: negative under 1 percent of nuclei; 1 to 10 percent reported as ER Low Positive (ASCO/CAP 2020) and behaving like triple-negative disease; HER2 immunohistochemistry 0 versus 1+ or 2+ without amplification (HER2-low), the line that now decides trastuzumab deruxtecan eligibility (ASCO-CAP 2023); Grade (almost always 3) and Ki-67 (median about 60 percent; prognostic and predictive within triple-negative disease but without a clinical-utility threshold); Intrinsic subtype (basal-like in about 79 percent) and the Lehmann or Burstein triple-negative subtype, research classifications with different chemotherapy response rates; Special histological type (adenoid cystic, secretory, low-grade adenosquamous, fibromatosis-like metaplastic), which can spare chemotherapy; TP53 mutation: 80% (80% of basal-like tumours in the TCGA breast study (Cancer Genome Atlas 2012)); PIK3CA mutation (amplification in a further tenth): 10-18% (9% of basal-like tumours (Cancer Genome Atlas 2012)); PTEN mutation or deletion (loss): 12-35% (PTEN mutation or loss in 35% of basal-like tumours, with INPP4B loss in 30% (Cancer Genome Atlas 2012)); RB1 mutation or deletion (loss): 15-20% (RB1 mutation or loss in 20% of basal-like tumours (Cancer Genome Atlas 2012)); BRCA1 germline pathogenic variant: 7-11% (8.5% of 1,824 TNBC patients unselected for family history (Couch 2015)); BRCA2 germline pathogenic variant: 3-4% (2.7% of 1,824 unselected patients (Couch 2015)); PALB2 germline or biallelic loss: 1-2% (1.2% of 1,824 unselected patients (Couch 2015)); Homologous recombination deficiency hrd (hrdetect-high, or hrd score 42 or more / tumour brca): 59-71% (HRDetect-high in 58.6% of 237 population-based TNBC whole genomes (35.9% low, 5.5% intermediate)); MYC amplification: 18-35% (cBioPortal: high-level amplification in 34 of 119 triple-negative samples, 28.6%, in brca_tcga_pub and 37 of 119, 31.1%, on the 2018 calls); PIK3CA / AKT1 / PTEN pi3k-akt pathway alteration (any of the three): 20-27% (28 of 140 first-line metastatic TNBC patients, 20%, in PAKT, where capivasertib gave a progression-free survival hazard ratio of 0.30 in that subgroup (Schmid 2020)); NOTCH1 / NOTCH2 / NOTCH3 activating rearrangement, pest-domain mutation or amplification: 5-9% (NOTCH1 and NOTCH2 rearrangements causing constitutive activation in 6 of 66 TNBCs, 9%, and in no other solid tumour type (Stoeck 2014)); EGFR amplification: 3-6% (EGFR amplified (gains included) in 23% of basal-like tumours, alongside PIK3CA 49%, KRAS 32% and BRAF 30% (Cancer Genome Atlas 2012)); Androgen receptor (LAR subtype) ar expression and luminal androgen receptor subtype: 12-16% (LAR was 16% of tumours by TNBCtype-4 and 9% by the original six-subtype call (Lehmann 2016)); Tumour mutational burden tmb 10 or more mutations per megabase: 4-5% (5% of 3,969 breast cancers of all subtypes were hypermutated, higher in HR-negative/HER2-negative and metastatic samples (8.4% metastatic versus 2.9% primary), with APOBEC (59.2%) and mismatch repair deficiency (36.4%) the dominant processes (Barroso-Sousa 2020, Ann Oncol)); MLH1 / MSH2 / MSH6 / PMS2 microsatellite instability or mismatch repair deficiency: 0-2% (No MSI-high tumour among 195 by PCR and one mismatch-repair-deficient tumour (lost MSH2) among 440 by IHC in Chinese TNBC (Ren 2021)); CD274 (PD-L1), SP142 immune-cell score ic 1% or more (sp142): 41-51% (46.4% of 614 centrally scored IMpassion130 samples (Rugo 2021)); CD274 (PD-L1), 22C3 combined positive score cps 10 or more (22c3): 27-38% (The CPS-10 subgroup of KEYNOTE-355 carried the overall survival benefit, 23.0 versus 16.1 months (Cortes 2022)); TROP2 (TACSTD2) protein expression (h-score) and amplification: 2-4% (Trop-2 expression was assessable in 290 of 468 ASCENT patients and sacituzumab govitecan benefit was seen at high and medium expression (progression-free survival 6.9 and 5.6 versus 2.5 and 2.2 months), with the low group too small to judge (Bardia 2021)); ERBB2 (HER2) her2-low (ihc 1+ or 2+/ish-negative): 24-37% (36.6% of triple-negative against 65.4% of hormone receptor-positive disease among 3,689 HER2-negative patients (Schettini 2021)); ERBB2 (HER2) her2-ultralow (ihc 0 with faint membrane staining in 10% or fewer cells): 38% (37.6% ultralow, 38.4% null and 24.0% low among 367 non-metastatic TNBCs); Stromal tumour-infiltrating lymphocytes stils (immune infiltration): 21-30% (Mean sTILs 23% with 77% of patients at 1% or more among 2,148 early TNBC patients on anthracycline chemotherapy (Loi 2019))

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/tnbc/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/tnbc/#overview [14 subtypes, 11 state-of-the-art points]
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/tnbc/#what-it-is [28 subtypes, 5 staging notes, 5 sites of spread]
- Finding it (own page): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/tnbc/finding-it/ [4 symptoms, 36 biomarkers, 28 prevalence rows]
- Treating it (own page): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/tnbc/treating-it/ [26 settings, 14 regimens, 21 decisions with options]
- Evidence (own page): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/tnbc/evidence/ [120 trials, 108 key papers, 40 milestones]
- The science (own page): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/tnbc/science/ [39 targets, 15 pathways, 9 preclinical models]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/tnbc/where-you-are/ [27 centres, 20 UK centres]
- Living with it (own page): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/tnbc/living-with-it/ [77 questions, 6 red cards, 1 decision aid]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/tnbc/coming/ [70 medicines, 119 trials, 50 ideas, 20 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/tnbc/data/ [792 connected records, 12 notes]

## Standard of care

- Stage I (T1a-b N0): Surgery ± radiation; chemotherapy for ≥T1c; TIL-high tumours have >90% 5-year RFS even without chemotherapy (OPTimal, ETNA, TIL-CHOICE cohorts). De-escalation trials ongoing. ([Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/))
- Stage II-III: Neoadjuvant pembrolizumab + carboplatin/paclitaxel → AC/EC, surgery, adjuvant pembrolizumab (KEYNOTE-522). Germline BRCA + residual disease: olaparib 1 year (OlympiA). Residual disease without BRCA: capecitabine (CREATE-X). Radiation per stage. ([KEYNOTE-522](https://onco.cc/trials/keynote-522/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Olaparib](https://onco.cc/drugs/olaparib/), [OlympiA](https://onco.cc/trials/olympia/))
- Metastatic, first line, PD-L1 CPS ≥10: Pembrolizumab + chemotherapy (KEYNOTE-355) or sacituzumab govitecan + pembrolizumab (ASCENT-04, approved 2026). ([KEYNOTE-355](https://onco.cc/trials/keynote-355/), [ASCENT-04 / KEYNOTE-D19](https://onco.cc/trials/ascent-04/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/))
- Metastatic, first line, PD-L1 negative or PD-1 ineligible: Datopotamab deruxtecan (TROPION-Breast02, OS benefit) or sacituzumab govitecan (ASCENT-03), both approved 2026; PARP inhibitor if germline BRCA; chemotherapy. ([TROPION-Breast02](https://onco.cc/trials/tropion-breast02/), [ASCENT-03](https://onco.cc/trials/ascent-03/), [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Olaparib](https://onco.cc/drugs/olaparib/))
- Metastatic, later lines: Whichever TROP2 ADC was not used first (cross-resistance uncertain); T-DXd if HER2-low (DESTINY-Breast04); iza-bren where available; chemotherapy (eribulin, capecitabine); clinical trials. ([Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Izalontamab brengitecan](https://onco.cc/drugs/izalontamab-brengitecan/), [DESTINY-Breast04](https://onco.cc/trials/destiny-breast04/))
- Suspected cancer in primary care: Suspected cancer pathway referral for an unexplained breast lump at 30 or over, or discharge, retraction or other change in one nipple at 50 or over; consider it for skin changes or an unexplained axillary lump at 30 or over; non-urgent referral for a lump under 30 (NICE NG12 1.4). The clinic does triple assessment: examination, mammogram, ultrasound and core biopsy. ([Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [Ultrasound](https://onco.cc/technologies/ultrasound/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Interval breast cancer (a cancer found between screening rounds)](https://onco.cc/terms/interval-breast-cancer/))
- Receptor testing that defines the subtype: ER, PR and HER2 assessed together on the diagnostic biopsy by quality-assured immunohistochemistry and reported quantitatively (NG101 1.3.1 to 1.3.4): ER and PR negative under 1 percent, ER 1 to 10 percent reported as low positive, HER2 0 or 1+ or 2+ without amplification. HER2 0 versus 1+ is reported with a comment because HER2-low disease qualifies for trastuzumab deruxtecan. ([Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [ER and PR negative under 1 percent (the triple-negative threshold, and ER-low)](https://onco.cc/terms/er-pr-negative-threshold/), [HER2-low eligibility for trastuzumab deruxtecan, and TROP2 ADCs without a test (triple-negative disease)](https://onco.cc/terms/her2-low-and-trop2-adc-eligibility-tnbc/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/))
- Germline testing at diagnosis: Germline BRCA1 and BRCA2 testing for women under 50 with triple-negative breast cancer including those with no family history (NG101 1.3.6); UK mainstream criteria extend to all triple-negative disease under 60 and any breast cancer under 40; CG164's 10 percent carrier-probability rule for everyone else. A pathogenic variant opens adjuvant olaparib (TA886), informs surgery, and starts cascade testing of relatives. ([Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Germline BRCA testing criteria for triple-negative breast cancer (UK)](https://onco.cc/terms/germline-brca-testing-criteria-tnbc/), [BRCA-associated triple-negative breast cancer](https://onco.cc/cancers/brca-associated-tnbc/), [Olaparib](https://onco.cc/drugs/olaparib/), [OlympiA](https://onco.cc/trials/olympia/))
- Surveillance and risk reduction for BRCA carriers (before any cancer): Annual MRI from 30 to 49 and annual mammography from 40 to 69 for known BRCA1 or BRCA2 carriers (MRI sensitivity 77 percent against 40 percent for mammography in MARIBS); bilateral risk-reducing mastectomy for a small proportion of women from high-risk families after genetic counselling, cutting breast cancer risk by about 90 percent; tamoxifen or anastrozole are offered to women at high risk in general but did not reduce ER-negative breast cancer in the prevention trials. ([MRI](https://onco.cc/technologies/mri/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [Risk-reducing surgery for BRCA carriers (bilateral and contralateral mastectomy, salpingo-oophorectomy)](https://onco.cc/terms/risk-reducing-surgery-brca-carriers/), [Chemoprevention (tamoxifen, anastrozole, raloxifene) and ER-negative breast cancer](https://onco.cc/terms/chemoprevention-and-er-negative-breast-cancer/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Mastectomy](https://onco.cc/terms/mastectomy/))
- Staging and the pathology report: TNM 8th edition with the AJCC prognostic stage note; sentinel node biopsy rather than axillary clearance to stage a clinically node-negative axilla (NG101 1.4); after neoadjuvant treatment the report gives pathological complete response or residual cancer burden, which drive the adjuvant choices in the residual-disease rows. ([TNM staging](https://onco.cc/terms/tnm-staging/), [AJCC 8th edition prognostic stage for breast cancer](https://onco.cc/terms/ajcc-prognostic-stage-breast/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/))
- Chemotherapy before or after surgery: For most triple-negative cancers larger than 2 cm or with involved nodes, chemotherapy comes first (neoadjuvant): it can shrink the cancer so that breast-conserving surgery replaces a mastectomy, and the pathology report at surgery then shows how well it worked, which guides the treatment given afterwards. NICE NG101 (2025) says where neoadjuvant chemotherapy is indicated for triple-negative disease, offer a regimen containing a platinum, a taxane and an anthracycline, and discuss the trade-off: 85 rather than 81 out of 100 alive at 3 years with a platinum, against more neutropenic sepsis, low blood counts and anaemia. Very small node-negative cancers may go to surgery first, with chemotherapy afterwards decided on the final pathology. Macmillan: people with triple-negative breast cancer are more likely to have chemotherapy before surgery. ([KEYNOTE-522](https://onco.cc/trials/keynote-522/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/), [Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Mastectomy](https://onco.cc/terms/mastectomy/))
- Adding pembrolizumab before surgery: what PD-L1 means here: NICE TA851 recommends pembrolizumab with chemotherapy before surgery, then pembrolizumab alone for up to nine cycles after surgery, for triple-negative early breast cancer at high risk of recurrence or locally advanced disease (KEYNOTE-522: stage II to III). No PD-L1 test is needed at this stage: the trial's gain in complete responses (64.8% against 51.2%) and in survival (86.6% against 81.7% alive at 5 years) was seen whatever the PD-L1 result. The combined positive score of 10 or more decides pembrolizumab only for cancer that has spread. The cost is immune-related side effects, which can start at any time during or after treatment and occasionally leave a gland permanently underactive; carry the alert card and ring the 24-hour number for the symptoms on it. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [KEYNOTE-522](https://onco.cc/trials/keynote-522/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Combined positive score (CPS)](https://onco.cc/terms/cps/), [Tumour-infiltrating lymphocytes (TILs)](https://onco.cc/terms/tils/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/))
- Residual disease after chemotherapy: capecitabine or olaparib: The pathology report after neoadjuvant treatment is the strongest guide to what comes next. A pathological complete response (no invasive cancer left in breast or nodes) carries a good outlook and pembrolizumab simply continues. Residual disease is graded by residual cancer burden (RCB I to III); in triple-negative disease 10-year relapse-free survival fell from 86% after a complete response to 81%, 55% and 23% across the classes (Symmans 2017). For residual disease with a germline BRCA1 or BRCA2 variant, NICE TA886 recommends a year of olaparib (OlympiA: 4-year invasive disease-free survival 82.7% against 75.4%, with a survival gain). Without a BRCA variant, six to eight cycles of capecitabine is the usual offer (CREATE-X: 5-year survival 78.8% against 70.3% in triple-negative disease; hand-foot syndrome in 73%). Olaparib and capecitabine were not tested together, and there is no proven way to add both; trials, including ones guided by circulating tumour DNA, are the route beyond. The decision aid at /tools/tnbc-after-chemotherapy/ walks the report through these statements. ([Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point](https://onco.cc/terms/tnbc-residual-disease-decision/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Olaparib](https://onco.cc/drugs/olaparib/), [OlympiA](https://onco.cc/trials/olympia/), [CREATE-X](https://onco.cc/trials/create-x/), [ECOG-ACRIN EA1131](https://onco.cc/trials/ea1131/), [BRE12-158 (Hoosier Oncology Group)](https://onco.cc/trials/bre12-158/), [ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)](https://onco.cc/trials/ascent-05/), [TROPION-Breast03](https://onco.cc/trials/tropion-breast03/), [SWOG S1418 / NRG BR006](https://onco.cc/trials/swog-s1418/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/))
- Mastectomy or breast-conserving surgery, and when to reconstruct: Breast-conserving surgery (wide local excision) followed by radiotherapy is usually as effective as mastectomy (Macmillan); mastectomy is advised when the cancer is large compared with the breast, there are several areas of cancer, or after earlier chest radiotherapy, and some people choose it. Chemotherapy first often makes conservation possible. Cancer at the margin means further surgery (NICE NG101: re-excise at 0 mm, consider within 1 mm). NICE says offer reconstruction to everyone having a mastectomy, offer both immediate and delayed options whether or not they are available locally, and offer immediate reconstruction even to those who may need radiotherapy; its table lists the trade-offs (implants more affected by radiotherapy than flaps; complications can delay chemotherapy or radiotherapy; more time to decide with delayed reconstruction). Some people prefer no reconstruction. The armpit is staged with a sentinel node biopsy (1 to 3 nodes); removing all the nodes raises the risk of lymphoedema and is reserved for involved nodes that need clearing. ([Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Mastectomy](https://onco.cc/terms/mastectomy/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Compression, decongestive therapy and exercise for lymphoedema](https://onco.cc/technologies/lymphoedema-decongestive-therapy/))
- Radiotherapy after surgery: which schedule and where: After breast-conserving surgery the remaining breast is treated; after mastectomy the chest wall is treated when nodes were involved (macrometastases) or margins were involved, including after neoadjuvant chemotherapy where pretreatment tests showed involved nodes, and considered for node-negative T3 disease. NICE NG101 (2023): offer 26 Gy in 5 fractions over 1 week when the lymph nodes are not being treated (FAST-Forward: non-inferior to 40 Gy in 15 at 5 years), consider 40 Gy in 15 fractions over 3 weeks after implant reconstruction or where 3 weeks suits better, and offer 40 Gy in 15 fractions whenever regional nodes are irradiated (START-B). A boost to the tumour bed is offered where the risk of local recurrence is high. Partial-breast radiotherapy (IMPORT LOW) is reserved for low-risk ER-positive tumours in NICE's wording, so it rarely applies to triple-negative disease. Left-sided treatment often uses breath-hold to protect the heart. Skin reactions peak at the end and settle over 3 to 4 weeks. ([Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [FAST-Forward](https://onco.cc/trials/fast-forward/), [START-B (UK Standardisation of Breast Radiotherapy)](https://onco.cc/trials/start-b/), [IMPORT LOW](https://onco.cc/trials/import-low/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/), [Radiation dermatitis (skin reaction)](https://onco.cc/terms/radiation-dermatitis/))
- Fertility preservation before chemotherapy: Triple-negative breast cancer is more common under 40 and chemotherapy usually starts within weeks. NICE NG101 asks teams to advise everyone about options for preserving fertility and cross-refers to the NICE fertility guideline; Cancer Research UK says national guidelines expect the discussion at diagnosis. Options: embryo or egg freezing (about 2 to 3 weeks of ovarian stimulation, with random-start protocols to avoid delay), ovarian tissue freezing at a growing number of UK centres, and contraception during treatment because chemotherapy can damage eggs. NHS funding for freezing varies by area. Because this cancer has no hormone receptors there is no endocrine therapy to interrupt later; the question is protecting eggs before the first cycle, and asking early enough that the referral does not delay chemotherapy. ([Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/))
- Genetic testing and what a BRCA result means for your family: NICE NG101 says offer BRCA1 and BRCA2 testing to women under 50 with triple-negative breast cancer even with no family history; Breast Cancer Now says anyone diagnosed under 60 should be offered a referral to discuss testing, and the NHS test directory criteria that NICE points to for PARP inhibitor eligibility (R444.1) may make people over 60 eligible too. Testing is free on the NHS when a hospital specialist refers you, results take about 1 to 3 months, and a genetic counsellor helps with what the result means. A pathogenic variant: opens olaparib after chemotherapy for residual disease (NICE TA886) and a PARP inhibitor in metastatic disease; raises the question of risk-reducing surgery to the other breast and the ovaries, managed by a multidisciplinary team with counselling first (NICE CG164); and means each child has a 1 in 2 chance of carrying it, so relatives can be offered predictive testing. A variant of uncertain significance changes nothing yet. No variant found means relatives are not tested, though a strong family history may still raise risk. ([Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/), [Olaparib](https://onco.cc/drugs/olaparib/), [Mastectomy](https://onco.cc/terms/mastectomy/))
- First treatment for metastatic disease: the tests that decide: Three results decide the first treatment for cancer that has spread, so ask that all three are back before the choice is made, ideally on a fresh biopsy because receptors can change: PD-L1 combined positive score (CPS 10 or more opens pembrolizumab with chemotherapy, NICE TA801, or with sacituzumab govitecan), germline BRCA status (a PARP inhibitor, olaparib or talazoparib), and HER2 score (1+ or 2+ without amplification, HER2-low, opens trastuzumab deruxtecan after chemotherapy). The TROP2 antibody-drug conjugates sacituzumab govitecan and datopotamab deruxtecan were approved first line in 2026 with different side-effect profiles; NHS funding follows NICE appraisals (sacituzumab govitecan is funded after two prior therapies under TA819), so ask what applies where you are treated. Ask for the palliative care team from the start, and think about a trial before the first line, because eligibility narrows with each treatment. ([Combined positive score (CPS)](https://onco.cc/terms/cps/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [KEYNOTE-355](https://onco.cc/trials/keynote-355/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Olaparib](https://onco.cc/drugs/olaparib/), [Talazoparib](https://onco.cc/drugs/talazoparib/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/))
- Antibody-drug conjugates: what to expect and the side effects to report: An antibody-drug conjugate carries chemotherapy into cells that show its target (TROP2 for sacituzumab govitecan and datopotamab deruxtecan, HER2 for trastuzumab deruxtecan), given as a drip in cycles: sacituzumab govitecan on days 1 and 8 of 21. The effects are still chemotherapy-like. Sacituzumab govitecan: low white cells (boxed warning; growth factor injections are sometimes used) and diarrhoea (boxed warning; Macmillan's rule is ring the 24-hour line for 4 or more stools a day, stools at night, or anti-diarrhoea medicine not working within 24 hours), plus sickness, tiredness and hair loss. Datopotamab deruxtecan: mouth soreness, eye problems (the label requires eye examinations) and rarely lung inflammation. Trastuzumab deruxtecan: interstitial lung disease in about 15% (2.2% fatal in the pooled analysis), mostly in the first year, so any new cough, breathlessness or fever is reported immediately; also sickness and low counts. Blood tests before each dose; doses are delayed or reduced rather than pushed through. ([Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [ASCENT](https://onco.cc/trials/ascent/), [Neutropenia](https://onco.cc/terms/neutropenia/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/), [Ocular toxicity (keratopathy, blurred vision)](https://onco.cc/terms/ocular-toxicity/))
- Brain metastases: radiosurgery, whole-brain radiotherapy, surgery and drugs: Triple-negative breast cancer spreads to the brain more often than other breast subtypes: about 29% of people with metastatic disease in a 433-patient series (25% within two years), and 46% before death in an older 116-patient series. For 1 to 3 metastases of a size suitable for radiosurgery, stereotactic radiosurgery alone is generally preferred: in a randomised trial it caused less cognitive decline at 3 months than radiosurgery plus whole-brain radiotherapy (63.5% against 91.7%) with no difference in survival. Whole-brain radiotherapy is kept for many or widespread metastases, with hippocampal-sparing planning and memantine where possible. Surgery is considered for a single large metastasis causing pressure. Drug treatment for the rest of the body usually continues; activity of the antibody-drug conjugates in the brain is emerging but unproven (the palliation term carries the ASCENT, real-world and DEBBRAH figures). Steroids relieve swelling in the short term. Ask what the plan is for symptoms (headache, seizures, weakness) and who to ring. ([Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [Stereotactic radiosurgery (SRS)](https://onco.cc/terms/stereotactic-radiosurgery/), [Whole-brain radiotherapy (WBRT)](https://onco.cc/terms/wbrt/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life](https://onco.cc/terms/tnbc-symptom-control-palliation/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/))
- A clinical trial or standard treatment: At every stage a trial can be a reasonable choice beside standard treatment: ask what the comparison arm is, whether a placebo is used (the NHS says only where no proven treatment exists; in KEYNOTE-522 the control arm had chemotherapy plus placebo, never placebo alone), what extra visits, tests and travel are involved and whether travel is paid, and that you can leave at any time without it affecting your care. Trials open to triple-negative breast cancer include ones testing less treatment after a complete response (OptimICE-pCR), anthracycline-free chemotherapy (SCARLET), circulating tumour DNA-guided escalation, and new antibody-drug conjugates in metastatic disease; the Triple Negative Breast Cancer Foundation and Cancer Research UK run trial finders. NICE NG101 asks teams to discuss research opportunities and encourage trial entry. ([Clinical trial](https://onco.cc/terms/clinical-trial/), [Informed consent](https://onco.cc/terms/informed-consent/), [Placebo](https://onco.cc/terms/placebo/), [OptimICE-pCR (A012103)](https://onco.cc/trials/optimice-pcr/), [SCARLET (SWOG S2212)](https://onco.cc/trials/scarlet-s2212/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/))
- Choice of neoadjuvant backbone: the platinum debate: Carboplatin raises pathological complete response in every trial (GeparSixto 53.2 versus 36.9 percent, BrighTNess 58 versus 31, CALGB 40603) and improved disease-free survival in GeparSixto (hazard ratio 0.56) and event-free survival in BrighTNess (0.57) but not long-term outcomes in CALGB 40603 (not powered); it is part of the KEYNOTE-522 regimen and is standard in the UK. Adding veliparib to carboplatin added nothing (BrighTNess). Atezolizumab in place of pembrolizumab has no survival evidence (NeoTRIP, GeparDouze, ALEXANDRA). ([Carboplatin](https://onco.cc/drugs/carboplatin/), [GeparSixto](https://onco.cc/trials/geparsixto/), [BrighTNess](https://onco.cc/trials/brightness/), [CALGB 40603 (Alliance)](https://onco.cc/trials/calgb-40603/), [Veliparib](https://onco.cc/drugs/veliparib/), [NeoTRIP (NeoTRIPaPDL1)](https://onco.cc/trials/neotrip/), [GeparDouze / NSABP B-59](https://onco.cc/trials/gepardouze/), [ALEXANDRA / IMpassion030](https://onco.cc/trials/impassion030/))
- Germline BRCA1 or BRCA2 carriers: early-stage choices: About one in nine unselected triple-negative patients carries a germline BRCA1 or BRCA2 variant (11.2 percent, Couch 2015; 15.4 percent in a prospective registry, Sharma 2014; 17.2 percent in GeparSixto, Hahnen 2017); the testing rules are in the germline testing row. The result decides adjuvant olaparib (OlympiA, 82 percent triple-negative; NICE TA886), informs risk-reducing surgery, and in the UK offers PARTNER (olaparib with neoadjuvant carboplatin and paclitaxel, 30 sites). Platinum sensitivity is greatest in carriers (TNT: response 68 versus 33 percent with carboplatin versus docetaxel in metastatic disease). ([Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [OlympiA](https://onco.cc/trials/olympia/), [Olaparib](https://onco.cc/drugs/olaparib/), [PARTNER](https://onco.cc/trials/partner/), [TNT (Triple Negative Trial)](https://onco.cc/trials/tnt/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [BRCA-associated triple-negative breast cancer](https://onco.cc/cancers/brca-associated-tnbc/))
- Metastatic, germline BRCA1 or BRCA2: Olaparib (OlympiAD: progression-free survival 7.0 versus 4.2 months, hazard ratio 0.58; no overall survival gain overall, hazard ratio 0.51 in patients untreated for metastatic disease; NICE TA1040) or talazoparib (EMBRACA: 8.6 versus 5.6 months, hazard ratio 0.54; final overall survival hazard ratio 0.85; NICE TA952), with the lower-cost option first in England; a platinum doublet is the alternative (BROCADE3 control arm median survival 28.2 months); PARP inhibitor added to chemotherapy (veliparib, BROCADE3) improved progression-free but not overall survival and is not licensed. Sequence relative to PD-1 or TROP2 ADC first-line therapy is untested. ([Olaparib](https://onco.cc/drugs/olaparib/), [OlympiAD](https://onco.cc/trials/olympiad/), [Talazoparib](https://onco.cc/drugs/talazoparib/), [EMBRACA](https://onco.cc/trials/embraca/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [BROCADE3](https://onco.cc/trials/brocade3/), [Veliparib](https://onco.cc/drugs/veliparib/), [TNT (Triple Negative Trial)](https://onco.cc/trials/tnt/))
- Metastatic, HER2-low, after one or two lines of chemotherapy: Trastuzumab deruxtecan 5.4 mg/kg every 3 weeks (DESTINY-Breast04: overall survival 23.4 versus 16.8 months in all patients, hazard ratio 0.64; hormone-receptor-negative cohort of 63, progression-free survival 8.5 versus 2.9 months, hazard ratio 0.46; interstitial lung disease 12.1 percent, 0.8 percent fatal). Licensed in the US (2022) and EU (2023) for HER2-low regardless of hormone receptor status; not recommended by NICE (TA992, 29 July 2024; rapid review in development), so not commissioned in England. HER2-ultralow triple-negative disease has no licensed indication. ([Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [DESTINY-Breast04](https://onco.cc/trials/destiny-breast04/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/))
- Palliation of symptoms: bone, pleura, skin and end of life: Single-fraction radiotherapy for painful bone metastases with denosumab or zoledronic acid to reduce skeletal events; urgent radiotherapy or surgery for spinal cord compression; drainage with talc pleurodesis or an indwelling catheter for malignant pleural effusion; radiotherapy and wound care for chest wall recurrence; management of drug toxicities (hand-foot syndrome on capecitabine, neutropenia and diarrhoea on sacituzumab govitecan, stomatitis and eye symptoms on datopotamab deruxtecan, interstitial lung disease on trastuzumab deruxtecan); early integrated palliative care from diagnosis of metastatic disease. ([Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life](https://onco.cc/terms/tnbc-symptom-control-palliation/), [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Denosumab](https://onco.cc/drugs/denosumab/), [Zoledronic acid](https://onco.cc/drugs/zoledronic-acid/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/), [Neutropenia](https://onco.cc/terms/neutropenia/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/))

## State of the art

- Curative-intent: chemo-immunotherapy (KEYNOTE-522) cures more patients than ever; pCR ~65%. Adjuvant PARP inhibitor for BRCA carriers.
- Metastatic: ADCs first line (sacituzumab, Dato-DXd), ADC + IO for PD-L1+ disease; median OS in first-line trials now approaches two years, roughly double the 2015 figure.
- HER2-low reclassification gives a third of TNBC patients access to T-DXd.
- De-escalation is real: TIL-guided omission of chemotherapy in stage I; anthracycline-free and pembrolizumab-omission trials in stage II-III.
- Genomic landscape. TP53 mutation in about 80% (79 to 90% by cohort), PIK3CA 10 to 18%, PTEN loss 12 to 35%, RB1 loss 15 to 20%, MYC amplification 18 to 35%, EGFR amplification 3 to 6%, NOTCH activation 5 to 9%, PI3K-AKT pathway alteration 20 to 27%; germline BRCA1 7 to 11%, BRCA2 3 to 4%, PALB2 1 to 2%, and homologous recombination deficiency in 59 to 71% (mostly BRCA1 promoter methylation and sporadic scars rather than germline mutation). TMB 10 or more in 4 to 5% of early and 18% of pretreated metastatic disease; MSI-high 0 to 2%. Every figure and cohort is in the molecular table; the cBioPortal rows were computed on receptor-defined triple-negative subsets of TCGA, METABRIC and the MSK 2018 cohort.
- Subtypes. Lehmann's TNBCtype-4: BL1 35% (TP53 92%, unstable, platinum-sensitive, pCR 41%), BL2 22% (growth-factor signalling, pCR 18%), mesenchymal 25% (EMT, immune-cold, PRC2-silenced MHC-I, lung-tropic) and LAR 16% (AR-driven, PIK3CA 55%, AKT1 13%, bone-tropic, pCR 29%, worst prognosis, modest AR-antagonist benefit); the immunomodulatory signal (21 to 25%) is the lymphocyte infiltrate and carries the best prognosis. Burstein's BLIS and BLIA split basal-like disease by immune state; the FUSCC scheme repeats the four-way logic in 465 Chinese patients. By PAM50, 76% of TNBC is basal-like and 15% HER2-enriched.
- Immune biomarkers by assay. SP142 IC 1% or more (IMpassion130): 41 to 51%. 22C3 CPS 10 or more (KEYNOTE-355, ASCENT-04): 27 to 38%. The two agree weakly and are not interchangeable; a 22C3 or SP263 positive does not imply SP142 positivity, and the atezolizumab benefit sat in SP142-positive tumours. Stromal TILs average 23%, are 60% or more in about 30%, and predict chemotherapy response and survival with or without chemotherapy; spatial immune classes (immunoreactive, immune-cold B7-H4-high, stroma-restricted) refine the score.
- HER2 and TROP2. HER2-low (IHC 1+ or 2+/ISH-negative) is 24 to 37% of TNBC and on-label for trastuzumab deruxtecan after one line (DESTINY-Breast04, 63 hormone receptor-negative patients); ultralow is a further 38% but unlabelled in TNBC because DESTINY-Breast06 was hormone receptor-positive only. TROP2 is not tested: ASCENT benefit spanned high and medium H-scores and neither TROP2 antibody-drug conjugate requires an assay.
- Ancestry and geography. African ancestry carries a 3.8-fold odds of basal-like disease, more TP53 and fewer PIK3CA mutations, with about 44% of the subtype difference heritable and a distinct immune landscape; 46% of Nigerian breast cancers with receptor data are triple-negative and 14.7% carry a germline repair-gene variant. BRCA1 founder mutations dominate in the Bahamas (23% of unselected patients), Mexico (ex9-12del) and Ashkenazi Jews (185delAG); Chinese TNBC carries more PIK3CA; MSI-high is under 1% in China and Japan.
- ctDNA and molecular residual disease. Post-neoadjuvant ctDNA positivity (about a third of patients with residual disease, rising with residual cancer burden) carries a two- to four-fold relapse hazard independent of RCB; every pathological complete responder in I-SPY 2 was ctDNA-negative. Prospective surveillance (c-TRAK TN) found ctDNA in 27% by a year but most already had metastases and pembrolizumab cleared none, and brain-only relapse escapes detection. No TNBC approval uses ctDNA; it stratifies ASCENT-05 and the ZEST design.
- Testing. Germline BRCA1/2 (and PALB2) for every TNBC diagnosis (ASCO-SSO 2024; NHS R208 and R444.1), with results before surgery where possible; 22C3 CPS on a metastatic biopsy for pembrolizumab combinations; HER2 IHC re-read at the 0 versus 1+ boundary; a comprehensive tumour panel at relapse for TMB, MSI, PIK3CA/AKT1/PTEN and NOTCH; HRD scores and TROP2 IHC are research readouts with no breast label.

## Open problems

- Residual disease after KEYNOTE-522: no approved escalation beyond capecitabine/olaparib; ctDNA-guided trials needed.
- ADC sequencing: does a second TOP1-payload ADC work after the first? SATEEN/BRE-354 suggest limited efficacy; chemotherapy interposition debated.
- Patient selection for TROP2 ADCs: IHC does not predict; TROP2 PET and ctDNA are candidates.
- PD-L1-negative early disease has immunotherapy proven only in KEYNOTE-522's unselected population, no biomarker that spares anyone pembrolizumab, and no ADC yet in the curative setting.
- Brain metastases (up to 30-45% of metastatic TNBC) remain undertreated; ADC CNS activity is emerging but unproven.
- Mesenchymal/claudin-low biology (EMT, efflux pumps) resists chemotherapy, ADC payloads, and immunotherapy alike.
- Disparities: Black women have twice the TNBC incidence and worse outcomes; trial enrolment does not reflect this.
- No UK registry publishes triple-negative incidence or survival as a subtype; the UK share rests on Cancer Research UK's around 15 percent and on cohorts such as POSH, while SEER publishes rates by receptor status every year.
- ER 1 to 10 percent tumours behave like triple-negative disease yet are excluded from most triple-negative trials, so the evidence for immunotherapy and ADCs in that band is thin (Yoder 2022; Acs 2024).
- Chemoprevention for BRCA1 carriers: tamoxifen and anastrozole prevent ER-positive disease, which is not the cancer BRCA1 carriers mostly get; risk-reducing mastectomy and surveillance are the only proven options.
- PD-L1 assays disagree on about a quarter of tumours (SP142 46 percent positive, 22C3 73 percent, concordance 69 percent in IMpassion130; 27 percent CPS 10 or more against 51 percent SP142-positive in the Swedish early cohort); only 22C3 combined positive score of 10 has an approved drug attached, laboratories are not harmonised, and no assay predicts benefit from the first-line antibody-drug conjugate plus pembrolizumab combinations.
- Acting on ctDNA after residual disease failed once (c-TRAK TN: detection came after metastases were visible, and ctDNA misses brain-only relapse); the next design needs tumour-informed assays, a sample at surgery and an active drug, and has not been run.
- The disparity is measured in the United States and was measured once in the UK (POSH, women under 41, recruited to 2008); NHS statistics do not report triple-negative outcomes by ethnicity, and women of African ancestry, who carry a distinct immune landscape, remain under-represented in the trials that set the biomarker thresholds.
- Most homologous recombination deficiency in TNBC is not germline BRCA, yet the PARP inhibitor labels are germline-only and the HRD scores validated in ovarian cancer did not predict carboplatin benefit in advanced TNBC (TNT).
- The Lehmann subtypes predict chemotherapy response retrospectively but no prospective subtype-directed trial has changed a guideline; the mesenchymal and LAR subtypes have no approved targeted therapy.
- Capecitabine after residual disease (CREATE-X) was proven before pembrolizumab existed; no trial has tested it alongside adjuvant pembrolizumab, and the two ADC trials in that setting (ASCENT-05, TROPION-Breast03) will not report before 2027.
- The independent contribution of adjuvant pembrolizumab is unknown: KEYNOTE-522 gave it before and after surgery, OptimICE-pCR asks whether it can be dropped after a complete response, and SWOG S1418 asks whether it helps after residual disease without prior immunotherapy.
- Three atezolizumab phase 3 trials in early disease were negative or null while pembrolizumab succeeded; whether that is the drug, the PD-L1 rather than PD-1 target, the backbone or chance is unresolved, and it leaves PD-L1-negative early disease with immunotherapy proven only in KEYNOTE-522's unselected population.
- In England HER2-low triple-negative disease cannot receive trastuzumab deruxtecan (NICE TA992 not recommended), the first-line ADC indications await appraisal, and atezolizumab remains commissioned on a licence the United States withdrew; the UK and US pathways for metastatic disease have diverged.
- AKT inhibition failed twice in biomarker-selected metastatic disease (IPATunity130, CAPItello-290) despite positive phase 2 trials, so PIK3CA, AKT1 and PTEN alterations, present in a fifth to a quarter of tumours, are not actionable in triple-negative breast cancer today; PTEN loss may also mark immunotherapy resistance.

## Notes

- What does triple-negative actually mean? The cancer cells lack the three receptors other breast cancers are treated through: oestrogen receptor under 1 percent of nuclei, progesterone receptor under 1 percent, and HER2 scored 0 or 1+, or 2+ without gene amplification. Each is measured on the biopsy by immunohistochemistry (ASCO/CAP 2020 and 2018; NICE NG101 1.3). A tumour with ER of 1 to 10 percent is reported as ER Low Positive and behaves like triple-negative disease (Yoder 2022; Acs 2024).
- How common is it? About 10.8 percent of US breast cancers with a known subtype (SEER 21, 2019 to 2023) and around 15 percent on Cancer Research UK's page; roughly 12 percent in earlier US series (Howlader 2014). It is diagnosed younger: women under 40 have about 1.5 to 2 times the odds of a triple-negative diagnosis (Bauer 2007; Scott 2019).
- Why is it more common in Black women? In the United States the rate is 25.7 per 100,000 non-Hispanic Black women against 13.0 for non-Hispanic White women (SEER 21), and in the UK POSH cohort 26.1 percent of Black against 18.6 percent of White young patients had triple-negative tumours (Copson 2014). Reproductive patterns (parity without breastfeeding raises ER-negative risk in African American women, Palmer 2014), ancestry and access all contribute; the causes are not settled (Howard and Olopade 2021).
- Should I have a genetic test? NICE says yes for women under 50 with triple-negative disease even without a family history (NG101 1.3.6), and UK mainstream criteria extend testing to all triple-negative disease under 60 (Evans 2024); about 11 percent of unselected triple-negative patients carry a BRCA1 or BRCA2 mutation and 14.6 percent a mutation in one of 17 genes (Couch 2015). The result changes surgery options, opens olaparib after chemotherapy for high-risk early disease (NICE TA886) and matters for relatives.
- Is it more dangerous than other breast cancers? Stage for stage, survival is lower: 78.7 percent five-year relative survival against 95.8 percent for hormone receptor-positive, HER2-negative disease in SEER, but 92.8 percent when found while localised. The risk of relapse is concentrated in the first three to five years and is low afterwards (Dent 2007), and a pathological complete response to chemotherapy before surgery carries an excellent outlook (Liedtke 2008; Cortazar 2014).
- Why did my treatment start with chemotherapy rather than surgery? For tumours over 2 cm or with node involvement, chemotherapy with pembrolizumab is given first because the response at surgery predicts relapse and directs what follows, and because it raised five-year survival from 81.7 to 86.6 percent in KEYNOTE-522 (Schmid 2024). NICE recommends a platinum, a taxane and an anthracycline in that setting (NG101 1.8, 2025) and pembrolizumab with it (TA851).
- Does hormone therapy or tamoxifen have any role? Not to treat triple-negative disease, which has no oestrogen receptor to block. As prevention, tamoxifen and anastrozole reduced ER-positive but not ER-negative breast cancer in the prevention trials (Cuzick 2015; Fisher 1998; Cuzick 2020), although tamoxifen after a first cancer was associated with fewer contralateral cancers in BRCA carriers (Phillips 2013).
- Will screening pick it up? The NHS invites women from 50 to 71 every three years (NHS). Triple-negative cancers are less often screen-detected (29 percent against 48 percent, Lin 2012) because they arise younger and grow between rounds. Known BRCA carriers are offered annual MRI from 30 and mammography from 40 (NICE CG164); anyone with a new breast change should see a GP without waiting for the next screen.
- What are the subtypes I might read about? Gene expression divides triple-negative disease into basal-like 1 and 2, mesenchymal and luminal androgen receptor tumours (Lehmann 2016), which respond differently to chemotherapy (pathological complete response 41 percent for basal-like 1, 18 percent for basal-like 2, 29 percent for luminal androgen receptor) but are not used to choose treatment in the NHS. Special histological types such as adenoid cystic and secretory carcinoma are triple-negative but indolent and may need no chemotherapy (Cserni 2021). Each has a page linked from this record.
- What is HER2-low and why does it matter if I am HER2-negative? HER2 1+, or 2+ without amplification, is called HER2-low; those tumours (63 of 557 patients in DESTINY-Breast04 had hormone receptor-negative disease) responded to trastuzumab deruxtecan, so the pathologist's distinction between 0 and 1+ now has a treatment consequence (Modi 2022; ASCO-CAP 2023).
- Frequencies marked cBioPortal were computed from the public API on 24 September 2026 on receptor-defined triple-negative subsets of brca_tcga_pub (123 samples; the same patients read in brca_tcga_pan_can_atlas_2018), brca_metabric (320) and breast_msk_2018 (176), as sample-level counts of non-synonymous mutation, high-level amplification or deep deletion over the subset; they are not the papers' own percentages, which are quoted alongside.
- Metastatic samples in breast_msk_2018 (85 of 176) and the 173-gene METABRIC panel make cross-cohort comparison approximate; TMB on the MSK panel is reported as a mutation count, not a per-megabase rate.

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- NICE TA819: sacituzumab govitecan for unresectable triple-negative advanced breast cancer after 2 or more therapies: https://www.nice.org.uk/guidance/ta819
- Triple Negative Breast Cancer Foundation: newly diagnosed: https://tnbcfoundation.org/living-with-tnbc/newly-diagnosed
- ESMO: breast cancer, a guide for patients: https://www.esmo.org/for-patients/patient-guides/breast-cancer
- Macmillan: carboplatin and paclitaxel, EC and pembrolizumab (the KEYNOTE-522 regimen): https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/carboplatin-paclitaxel-ec-pembrolizumab
- Macmillan: questions to ask your healthcare team: https://www.macmillan.org.uk/cancer-information-and-support/treatment/your-treatment-options/questions-to-ask-your-healthcare-team
- Cancer Research UK: chemotherapy for breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/chemotherapy
- Cancer Research UK: having radiotherapy for breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/radiotherapy/radiotherapy-treatment
- Macmillan: radiotherapy for breast cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/radiotherapy-for-breast-cancer
- Breast Cancer Now: radiotherapy for primary breast cancer: https://breastcancernow.org/about-breast-cancer/treatment/radiotherapy-for-primary-breast-cancer
- Cancer Research UK: prehabilitation: https://www.cancerresearchuk.org/about-cancer/treatment/prehabilitation
- Macmillan: chemotherapy for breast cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/chemotherapy-for-breast-cancer
- Macmillan: surgery to the lymph nodes for breast cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-to-the-lymph-nodes-for-breast-cancer
- Breast Cancer Now: genetic testing for altered breast cancer genes: https://breastcancernow.org/about-breast-cancer/awareness/breast-cancer-in-families/genetic-testing-for-altered-breast-cancer-genes
- Macmillan: BRCA1 and BRCA2 genes: https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/causes-and-risk-factors/brca-gene
- Macmillan: clinical trials: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/clinical-trials
- Schmid et al., overall survival with pembrolizumab in early-stage triple-negative breast cancer, KEYNOTE-522 (NEJM 2024): https://doi.org/10.1056/NEJMoa2409932
- Schmid et al., pembrolizumab for early triple-negative breast cancer, KEYNOTE-522 (NEJM 2020): https://doi.org/10.1056/NEJMoa1910549
- Masuda et al., adjuvant capecitabine after preoperative chemotherapy, CREATE-X (NEJM 2017): https://doi.org/10.1056/NEJMoa1612645
- Tutt et al., adjuvant olaparib for BRCA1- or BRCA2-mutated breast cancer, OlympiA (NEJM 2021): https://doi.org/10.1056/NEJMoa2105215
- Geyer et al., overall survival in OlympiA (Annals of Oncology 2022): https://doi.org/10.1016/j.annonc.2022.09.159
- Symmans et al., long-term prognostic risk after neoadjuvant chemotherapy by residual cancer burden and subtype (JCO 2017): https://doi.org/10.1200/JCO.2015.63.1010
- Yau et al., residual cancer burden and long-term survival, pooled analysis of 5,161 patients (Lancet Oncology 2022): https://doi.org/10.1016/S1470-2045(21)00589-1
- Cortes et al., pembrolizumab plus chemotherapy in advanced triple-negative breast cancer, KEYNOTE-355 (NEJM 2022): https://doi.org/10.1056/NEJMoa2202809
- Murray Brunt et al., FAST-Forward: 1 week versus 3 weeks of breast radiotherapy, 5-year results (Lancet 2020): https://doi.org/10.1016/S0140-6736(20)30932-6
- Haviland et al., START trials of breast radiotherapy hypofractionation, 10-year results (Lancet Oncology 2013): https://doi.org/10.1016/S1470-2045(13)70386-3
- Coles et al., partial-breast radiotherapy after breast conservation, IMPORT LOW (Lancet 2017): https://doi.org/10.1016/S0140-6736(17)31145-5
- Macmillan: olaparib: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/olaparib
- Breast Cancer Now: olaparib (Lynparza): https://breastcancernow.org/about-breast-cancer/treatment/targeted-therapy/olaparib-lynparza
- Breast Cancer Now: pembrolizumab (Keytruda): https://breastcancernow.org/about-breast-cancer/treatment/targeted-therapy/pembrolizumab-keytruda
- NHS: genetic and genomic testing: https://www.nhs.uk/tests-and-treatments/genetic-and-genomic-testing/
- NHS: clinical trials: https://www.nhs.uk/tests-and-treatments/clinical-trials/
- Macmillan: tiredness (fatigue): https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/tiredness

## Connected records

- roadmaps: [ADC roadmap: from Mylotarg to bispecific and dual-payload ADCs](https://onco.cc/roadmaps/adc-generations/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [TNBC roadmap: from 'nothing to target' to ADC + immunotherapy first line](https://onco.cc/roadmaps/tnbc-history/), [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/), [TROP2 ADC roadmap: sacituzumab govitecan → Dato-DXd → sac-TMT → bispecifics and PET](https://onco.cc/roadmaps/trop2-adc-roadmap/)
- pairings: [ADC + checkpoint inhibitor](https://onco.cc/pairings/adc-plus-io/), [Caution: cumulative anthracycline dose and the heart](https://onco.cc/pairings/doxorubicin-cardio-caution/), [Caution: TOP1 ADC immediately after TOP1 ADC](https://onco.cc/pairings/adc-after-adc-caution/), [ctDNA MRD → adjuvant therapy decision](https://onco.cc/pairings/ctdna-mrd-to-adjuvant/), [Germline BRCA test → adjuvant PARP inhibitor](https://onco.cc/pairings/germline-to-parp/), [HER2-low scoring → T-DXd](https://onco.cc/pairings/her2-low-to-tdxd/), [Platinum chemotherapy in HRD tumours](https://onco.cc/pairings/platinum-plus-hrd/), [TROP2 PET → TROP2 ADC selection](https://onco.cc/pairings/trop2-pet-to-adc/)
- collections: [Living Beyond Breast Cancer](https://onco.cc/collections/src-lbbc/), [Susan G. Komen](https://onco.cc/collections/susan-g-komen/), [Triple Negative Breast Cancer Foundation](https://onco.cc/collections/src-tnbc-foundation/)
- cancers: [Adenoid cystic carcinoma of the breast](https://onco.cc/cancers/adenoid-cystic-carcinoma-breast/), [Apocrine carcinoma of the breast](https://onco.cc/cancers/apocrine-carcinoma-breast/), [Basal-like 1 triple-negative breast cancer (BL1)](https://onco.cc/cancers/tnbc-basal-like-1/), [Basal-like 2 triple-negative breast cancer (BL2)](https://onco.cc/cancers/tnbc-basal-like-2/), [BRCA-associated triple-negative breast cancer](https://onco.cc/cancers/brca-associated-tnbc/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Carcinoma with medullary pattern (medullary breast cancer)](https://onco.cc/cancers/medullary-pattern-breast-carcinoma/), [Ductal carcinoma in situ (DCIS)](https://onco.cc/cancers/ductal-carcinoma-in-situ/), [Early triple-negative breast cancer](https://onco.cc/cancers/tnbc-early/), [HER2-low and HER2-ultralow metastatic breast cancer](https://onco.cc/cancers/her2-low-metastatic-breast-cancer/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Immunomodulatory triple-negative breast cancer (IM)](https://onco.cc/cancers/tnbc-immunomodulatory/), [Inflammatory breast cancer](https://onco.cc/cancers/inflammatory-breast-cancer/), [Invasive breast carcinoma of no special type (invasive ductal carcinoma)](https://onco.cc/cancers/invasive-breast-carcinoma-no-special-type/), [Invasive breast carcinoma with medullary pattern (medullary carcinoma)](https://onco.cc/cancers/breast-carcinoma-medullary-pattern/), [Luminal androgen receptor triple-negative breast cancer (LAR)](https://onco.cc/cancers/tnbc-luminal-androgen-receptor/), [Male breast cancer](https://onco.cc/cancers/male-breast-cancer/), [Mesenchymal stem-like triple-negative breast cancer (MSL)](https://onco.cc/cancers/tnbc-mesenchymal-stem-like/), [Mesenchymal triple-negative breast cancer (M)](https://onco.cc/cancers/tnbc-mesenchymal/), [Metaplastic breast carcinoma](https://onco.cc/cancers/metaplastic-breast-carcinoma/), [Metastatic triple-negative breast cancer](https://onco.cc/cancers/tnbc-metastatic/), [Secretory carcinoma of the breast](https://onco.cc/cancers/secretory-carcinoma-breast/)
- ideas: [A billion-dollar prize for the first durable cure of a lethal metastatic cancer](https://onco.cc/ideas/idea-fund-cure-prize/), [A bone drug to prevent breast cancer in BRCA1 carriers](https://onco.cc/ideas/idea-prev-brca1-denosumab-prevention/), [A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled](https://onco.cc/ideas/idea-moon-mrd-weather-service/), [A permanent neutral non-profit sponsor for multi-company platform trials](https://onco.cc/ideas/idea-fund-neutral-platform-sponsor/), [A platform trial of very-low-cost metronomic chemotherapy in LMIC common cancers](https://onco.cc/ideas/idea-acc-metronomic-lmic-platform-trial/), [A randomised trial of antibody-drug conjugate sequence in metastatic triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-adc-sequencing-trial/), [A ring-fenced metastasis programme with metastasis-specific endpoints](https://onco.cc/ideas/idea-fund-metastasis-moonshot/), [A UK audit of trial access and germline testing uptake in triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-uk-trial-access-and-germline-testing-audit/), [ADC for residual disease after KEYNOTE-522](https://onco.cc/ideas/idea-post-neoadjuvant-adc/), [AI quantification of HER2-low and HER2-ultralow](https://onco.cc/ideas/idea-ai-her2-low-scoring/), [Alpha radioligands after ADC failure](https://onco.cc/ideas/idea-alpha-after-adc/), [Block the recycling that keeps dormant cells alive](https://onco.cc/ideas/idea-bio2-autophagy-block-mrd/), [Can MYC be drugged directly, and will patients tolerate it?](https://onco.cc/ideas/idea-drugging-myc/), [Cancer interception vaccines for high-risk carriers](https://onco.cc/ideas/idea-interception-vaccines/), [Close the gap between who gets triple-negative breast cancer and who is in its trials](https://onco.cc/ideas/idea-tnbc-disparities-in-access-and-outcomes/), [Confirm or refute the harm of antioxidant supplements during chemotherapy](https://onco.cc/ideas/idea-nl-antioxidant-supplement-harm-confirmation/), [ctDNA-guided adjuvant decisions after residual disease: escalate the positive, spare the negative](https://onco.cc/ideas/idea-tnbc-ctdna-guided-adjuvant-decisions/), [ctDNA-triggered escalation in early TNBC](https://onco.cc/ideas/idea-ctdna-escalation-tnbc/), [Cure-focused prizes: pay for verified long-term cures, not for drugs](https://onco.cc/ideas/idea-moon-cure-prizes/), [Default fertility preservation referral for every patient under 40 before treatment](https://onco.cc/ideas/idea-acc-default-fertility-preservation-referral/), [Dual-payload ADCs in first line to prevent resistance](https://onco.cc/ideas/idea-dual-payload-first/), [Efflux-agnostic therapy for mesenchymal TNBC](https://onco.cc/ideas/idea-efflux-agnostic/), [Ethnicity-stratified outcome reporting for triple-negative breast cancer in NHS cancer statistics](https://onco.cc/ideas/idea-tnbc-uk-ethnicity-stratified-outcome-reporting/), [Fertility preservation offered and funded by default before gonadotoxic treatment](https://onco.cc/ideas/idea-moon-fertility-preservation-default/), [Fix the neutrophil count rule that excludes many people of African ancestry](https://onco.cc/ideas/idea-tr1-duffy-null-neutrophil-threshold/), [Flush dormant cells out of bone marrow, then kill them](https://onco.cc/ideas/idea-bio2-cxcr4-mobilise-then-kill/), [Give exceptional responders less: pembrolizumab omission after complete response, anthracycline-free regimens and chemotherapy omission in lymphocyte-rich stage I disease](https://onco.cc/ideas/idea-tnbc-de-escalation-for-exceptional-responders/), [Harmonise PD-L1 testing for triple-negative breast cancer around one scored assay, with external quality assurance](https://onco.cc/ideas/idea-tnbc-pd-l1-assay-harmonisation/), [Implant a tiny device that tests twenty drugs inside the patient's own tumour](https://onco.cc/ideas/idea-bio2-implantable-microdevice-screen/), [Is aneuploidy itself a druggable vulnerability?](https://onco.cc/ideas/idea-targeting-aneuploidy/), [Metastasis prevention as a formal indication with its own trials and regulatory pathway](https://onco.cc/ideas/idea-moon-metastasis-prevention-indication/), [Neoadjuvant ADC + IO replacing anthracycline chemotherapy in TNBC](https://onco.cc/ideas/idea-neoadjuvant-adc-io/), [Off-the-shelf natural killer cells to sweep up residual disease](https://onco.cc/ideas/idea-bio2-nk-cells-for-mrd/), [One-stop breast clinics: imaging, biopsy and a preliminary answer in a single visit](https://onco.cc/ideas/idea-acc-one-stop-breast-diagnostic-clinic/), [One-two punch: clear senescent cells after chemotherapy](https://onco.cc/ideas/idea-senolytics-after-chemo/), [Patient-derived organoids to pick ADC payloads](https://onco.cc/ideas/idea-organoid-guided-adc/), [Payload-class switching as the rule for ADC sequencing](https://onco.cc/ideas/idea-payload-switching/), [Prospective arm-volume surveillance to catch and reverse lymphoedema early](https://onco.cc/ideas/idea-acc-lymphoedema-prospective-surveillance/), [Public country dashboards for the three WHO breast cancer targets](https://onco.cc/ideas/idea-acc-gbci-country-dashboards/), [Reflex re-scoring of HER2 0 versus 1+ with digital assistance so every eligible triple-negative patient reaches trastuzumab deruxtecan](https://onco.cc/ideas/idea-tnbc-her2-ultralow-testing-uptake/), [Sequential multiple-assignment randomised trials to find the best order of ADCs](https://onco.cc/ideas/idea-tr2-smart-sequencing-adc/), [Set each woman's mammogram interval from her last mammogram, using AI risk](https://onco.cc/ideas/idea-prev-ai-mammogram-risk-intervals/), [Starve MYC-driven tumours by blocking protein production machinery](https://onco.cc/ideas/idea-bio1-translation-dependency-myc/), [Stop over-excluding people who could become pregnant; study pregnancy exposure](https://onco.cc/ideas/idea-tr1-include-pregnancy-capable-people-sensibly/), [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/), [TIL-based omission of chemotherapy in stage I TNBC](https://onco.cc/ideas/idea-til-guided-deescalation/), [Trials that include, and report, brain metastases in triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-brain-metastasis-trials/), [TROP2 PET to choose and sequence TROP2 ADCs](https://onco.cc/ideas/idea-trop2-pet-selection/), [Turn chromosomal chaos into a weakness with KIF18A inhibitors](https://onco.cc/ideas/idea-bio1-cin-vulnerability-kif18a/), [What decides which disseminated cells ever colonise?](https://onco.cc/ideas/idea-dtc-colonisation-determinants/)
- biomarkers: [AKT1 E17K mutation](https://onco.cc/biomarkers/akt1-e17k/), [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/), [dMMR (mismatch repair deficiency by IHC)](https://onco.cc/biomarkers/dmmr-ihc/), [Germline BRCA1/2 pathogenic variant (gBRCAm)](https://onco.cc/biomarkers/brca-germline/), [HER2 IHC 0 (HER2-negative, including ultralow)](https://onco.cc/biomarkers/her2-ihc-0/), [HER2-low (IHC 1+ or IHC 2+/ISH-negative)](https://onco.cc/biomarkers/her2-low-ihc/), [HER2-ultralow (IHC 0 with membrane staining)](https://onco.cc/biomarkers/her2-ultralow/), [HRD-positive (genomic instability score)](https://onco.cc/biomarkers/hrd-positive/), [MSI-high (microsatellite instability by PCR or sequencing)](https://onco.cc/biomarkers/msi-high/), [PD-L1 CPS (combined positive score)](https://onco.cc/biomarkers/pd-l1-cps/), [PD-L1 IC score (immune-cell score, SP142)](https://onco.cc/biomarkers/pd-l1-ic-score/), [PIK3CA mutation](https://onco.cc/biomarkers/pik3ca-hotspot-mutation/), [PTEN alteration (sequencing) and PTEN loss (IHC)](https://onco.cc/biomarkers/pten-alteration/), [TMB-high (tumour mutational burden >= 10 mutations per megabase)](https://onco.cc/biomarkers/tmb-high/), [TP53 mutation and del(17p)](https://onco.cc/biomarkers/tp53-del17p/), [TROP2 expression](https://onco.cc/biomarkers/trop2-expression/), [Tumour (somatic or germline) BRCA1/2 mutation and HRR gene alterations](https://onco.cc/biomarkers/brca-somatic/)
- technologies: [Acupuncture for chemotherapy-induced neuropathy](https://onco.cc/technologies/acupuncture-chemotherapy-neuropathy/), [Acupuncture for hot flushes on endocrine therapy](https://onco.cc/technologies/acupuncture-hot-flushes/), [AI-assisted mammography screening](https://onco.cc/technologies/ai-mammography-screening/), [Alternative medicine used instead of standard treatment](https://onco.cc/technologies/alternative-medicine-instead-of-treatment/), [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [Bispecific ADC](https://onco.cc/technologies/bispecific-adc/), [Cancer interception vaccines](https://onco.cc/technologies/interception-vaccination/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Clinical hypnosis for procedures, pain and hot flushes](https://onco.cc/technologies/hypnosis-cancer-care/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Compression, decongestive therapy and exercise for lymphoedema](https://onco.cc/technologies/lymphoedema-decongestive-therapy/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [Dietary supplements during cancer treatment: interactions and harms](https://onco.cc/technologies/dietary-supplements-treatment-interactions/), [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/), [Dual-payload ADC](https://onco.cc/technologies/dual-payload-adc/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [FAPI PET](https://onco.cc/technologies/fapi-pet/), [Fasting and fasting-mimicking diets around chemotherapy](https://onco.cc/technologies/fasting-mimicking-diet/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [HRD & BRCA testing](https://onco.cc/technologies/hrd-testing/), [HRD genomic scar scores (GIS, LOH, HRDetect)](https://onco.cc/technologies/hrd-genomic-scar-scores/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Intratumoural gene electrotransfer (IL-12 plasmid)](https://onco.cc/technologies/il12-electroporation/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss](https://onco.cc/technologies/minoxidil-chemotherapy-alopecia/), [Mirai (MIT breast cancer risk from mammograms)](https://onco.cc/technologies/mirai/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [MRI](https://onco.cc/technologies/mri/), [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Norton-Simon hypothesis and dose-dense chemotherapy](https://onco.cc/technologies/norton-simon-hypothesis/), [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/), [PARP PET](https://onco.cc/technologies/parp-pet/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/), [Personalised neoantigen (mRNA) vaccines](https://onco.cc/technologies/neoantigen-mrna-vaccine/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Platinum agents](https://onco.cc/technologies/platinum/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [RAD51 foci assay (functional HRD test)](https://onco.cc/technologies/rad51-foci-assay/), [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Surface-guided radiotherapy (SGRT)](https://onco.cc/technologies/surface-guided-radiotherapy/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [TROP2 PET](https://onco.cc/technologies/trop2-pet/), [Tumour mutational burden testing](https://onco.cc/technologies/tmb-testing/), [UGT1A1 genotyping before irinotecan](https://onco.cc/technologies/ugt1a1-genotyping/), [Ultrasound](https://onco.cc/technologies/ultrasound/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/), [Yoga during and after cancer treatment](https://onco.cc/technologies/yoga-cancer/)
- targets: [AKT](https://onco.cc/targets/akt/), [Androgen receptor](https://onco.cc/targets/androgen-receptor/), [ATR](https://onco.cc/targets/atr/), [B7-H4 (VTCN1)](https://onco.cc/targets/b7h4/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [BRD4](https://onco.cc/targets/brd4/), [CD73 / adenosine axis](https://onco.cc/targets/cd73-adenosine/), [CDK2](https://onco.cc/targets/cdk2/), [EGFR](https://onco.cc/targets/egfr/), [FAP](https://onco.cc/targets/fap/), [Folate receptor alpha](https://onco.cc/targets/folr1/), [HER2](https://onco.cc/targets/her2/), [HER3](https://onco.cc/targets/her3/), [LIV-1 (SLC39A6)](https://onco.cc/targets/liv1/), [Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)](https://onco.cc/targets/mmr/), [MYC](https://onco.cc/targets/myc-gene/), [Nectin-4](https://onco.cc/targets/nectin4/), [NOTCH1](https://onco.cc/targets/notch1/), [ORC1](https://onco.cc/targets/orc1/), [PALB2](https://onco.cc/targets/palb2/), [PARP](https://onco.cc/targets/parp/), [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/), [PIK3CA / PI3K-alpha](https://onco.cc/targets/pik3ca/), [PTEN](https://onco.cc/targets/pten/), [PTK6 (BRK)](https://onco.cc/targets/ptk6/), [PTPN12](https://onco.cc/targets/ptpn12/), [RB1](https://onco.cc/targets/rb1/), [ROR1](https://onco.cc/targets/ror1/), [Topoisomerase I (TOP1)](https://onco.cc/targets/top1/), [TP53](https://onco.cc/targets/tp53/), [TROP2](https://onco.cc/targets/trop2/), [WEE1](https://onco.cc/targets/wee1/), [XRCC3](https://onco.cc/targets/xrcc3/)
- drugs: [Adagloxad simolenin](https://onco.cc/drugs/adagloxad-simolenin/), [Adavosertib](https://onco.cc/drugs/adavosertib/), [AK117](https://onco.cc/drugs/ak117/), [AK146D1](https://onco.cc/drugs/ak146d1/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Avelumab](https://onco.cc/drugs/avelumab/), [AVZO-021](https://onco.cc/drugs/avzo-021/), [BEBT-209](https://onco.cc/drugs/bebt-209/), [Bicalutamide](https://onco.cc/drugs/bicalutamide/), [BRACAnalysis CDx](https://onco.cc/drugs/bracanalysis-cdx/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Capivasertib](https://onco.cc/drugs/capivasertib/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Ceralasertib](https://onco.cc/drugs/ceralasertib/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Denosumab](https://onco.cc/drugs/denosumab/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Enzalutamide](https://onco.cc/drugs/enzalutamide/), [Epirubicin](https://onco.cc/drugs/epirubicin/), [Eribulin](https://onco.cc/drugs/eribulin/), [ESG401](https://onco.cc/drugs/esg401/), [FAP-2286 (177Lu / 68Ga)](https://onco.cc/drugs/fap-2286/), [FDA018-ADC](https://onco.cc/drugs/fda018-adc/), [FoundationOne CDx / Liquid CDx](https://onco.cc/drugs/foundationone-cdx/), [Guardant Reveal](https://onco.cc/drugs/guardant-reveal/), [HER2 IHC and ISH companion assays (HercepTest, PATHWAY 4B5, HER2 Dual ISH)](https://onco.cc/drugs/her2-testing-assays/), [Iniparib](https://onco.cc/drugs/iniparib/), [Ipatasertib](https://onco.cc/drugs/ipatasertib/), [Ivermectin](https://onco.cc/drugs/ivermectin/), [Ivonescimab](https://onco.cc/drugs/ivonescimab/), [Ixabepilone](https://onco.cc/drugs/ixabepilone/), [Izalontamab brengitecan](https://onco.cc/drugs/izalontamab-brengitecan/), [JK08](https://onco.cc/drugs/jk08/), [JSKN016](https://onco.cc/drugs/jskn016/), [LP-184](https://onco.cc/drugs/lp-184/), [Lunit INSIGHT MMG](https://onco.cc/drugs/lunit-insight-mmg/), [MI Cancer Seek](https://onco.cc/drugs/caris-mi-cancer-seek/), [Mia (Mammography Intelligent Assessment)](https://onco.cc/drugs/kheiron-mia/), [myChoice CDx](https://onco.cc/drugs/mychoice-cdx/), [Nab-paclitaxel](https://onco.cc/drugs/nab-paclitaxel/), [Olaparib](https://onco.cc/drugs/olaparib/), [Oleclumab](https://onco.cc/drugs/oleclumab/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Patritumab deruxtecan](https://onco.cc/drugs/patritumab-deruxtecan/), [PD-L1 IHC 22C3 pharmDx](https://onco.cc/drugs/dako-pd-l1-22c3-pharmdx/), [Pegulicianine](https://onco.cc/drugs/pegulicianine/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [PM8002](https://onco.cc/drugs/pm8002/), [ProFound AI (iCAD)](https://onco.cc/drugs/icad-profound-ai/), [Puxitatug samrotecan](https://onco.cc/drugs/puxitatug-samrotecan/), [RaDaR](https://onco.cc/drugs/radar-mrd/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Sacituzumab tirumotecan](https://onco.cc/drugs/sacituzumab-tirumotecan/), [Signatera](https://onco.cc/drugs/signatera/), [Talazoparib](https://onco.cc/drugs/talazoparib/), [Tempus xT CDx](https://onco.cc/drugs/tempus-xt-cdx/), [Tenalisib](https://onco.cc/drugs/tenalisib/), [Transpara](https://onco.cc/drugs/transpara/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [TruSight Oncology Comprehensive](https://onco.cc/drugs/trusight-oncology-comprehensive/), [Veliparib](https://onco.cc/drugs/veliparib/), [VENTANA MMR RxDx Panel](https://onco.cc/drugs/ventana-mmr-rxdx/), [VENTANA PD-L1 (SP142) Assay](https://onco.cc/drugs/ventana-pd-l1-sp142/), [VENTANA PD-L1 (SP263) Assay](https://onco.cc/drugs/ventana-pd-l1-sp263/), [ZEN-3694](https://onco.cc/drugs/zen-3694/), [Zoledronic acid](https://onco.cc/drugs/zoledronic-acid/)
- companies: [A2 Biotherapeutics](https://onco.cc/companies/a2-biotherapeutics/), [Alliance for Clinical Trials in Oncology](https://onco.cc/companies/alliance-oncology/), [AstraZeneca](https://onco.cc/companies/astrazeneca/), [Ataraxis AI](https://onco.cc/companies/ataraxis-ai/), [Boundless Bio](https://onco.cc/companies/boundless-bio/), [Breast Cancer Trials](https://onco.cc/companies/breast-cancer-trials/), [Breast International Group (BIG)](https://onco.cc/companies/big/), [Bristol Myers Squibb](https://onco.cc/companies/bms/), [Celldex Therapeutics](https://onco.cc/companies/celldex/), [Circle Pharma](https://onco.cc/companies/circle-pharma/), [Clear Gene](https://onco.cc/companies/clear-gene/), [Compass Therapeutics](https://onco.cc/companies/compass-therapeutics/), [Daiichi Sankyo](https://onco.cc/companies/daiichi-sankyo/), [Danish Breast Cancer Group](https://onco.cc/companies/dbcg/), [Dantari](https://onco.cc/companies/dantari/), [G1 Therapeutics](https://onco.cc/companies/g1-therapeutics/), [GEICAM Spanish Breast Cancer Group](https://onco.cc/companies/geicam/), [German Breast Group (GBG)](https://onco.cc/companies/gbg/), [Gilead Sciences (incl. Kite)](https://onco.cc/companies/gilead/), [Haystack Oncology](https://onco.cc/companies/haystack-oncology/), [HiberCell](https://onco.cc/companies/hibercell/), [iSono Health](https://onco.cc/companies/isono-health/), [Kheiron Medical Technologies](https://onco.cc/companies/kheiron-medical-technologies/), [Lumicell](https://onco.cc/companies/lumicell/), [Lunit](https://onco.cc/companies/lunit/), [Mabwell (Shanghai) Bioscience](https://onco.cc/companies/mabwell-shanghai-bioscience/), [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Mersana Therapeutics](https://onco.cc/companies/mersana/), [Nanjing Leads Biolabs](https://onco.cc/companies/nanjing-leads-biolabs/), [NatureCeuticals](https://onco.cc/companies/natureceuticals/), [NearWave](https://onco.cc/companies/nearwave/), [NEC Bio](https://onco.cc/companies/nec-bio/), [NRG Oncology](https://onco.cc/companies/nrg-oncology/), [Outcomes4Me](https://onco.cc/companies/outcomes4me/), [Perimeter Medical Imaging AI](https://onco.cc/companies/perimeter-medical-imaging-ai/), [Qilu Pharmaceutical](https://onco.cc/companies/qilu-pharmaceutical/), [Scancell](https://onco.cc/companies/scancell/), [Sichuan Kelun-Biotech](https://onco.cc/companies/kelun-biotech/), [SOLTI Cancer Research Group](https://onco.cc/companies/solti/), [SWOG Cancer Research Network](https://onco.cc/companies/swog/), [SystImmune / Sichuan Biokin](https://onco.cc/companies/systimmune/), [Therapixel](https://onco.cc/companies/therapixel/), [UNICANCER](https://onco.cc/companies/unicancer/), [Vara](https://onco.cc/companies/vara/), [Volpara Health](https://onco.cc/companies/volpara-health/)
- institutions: [Addenbrooke's Hospital, Cambridge University Hospitals](https://onco.cc/institutions/addenbrookes-cambridge/), [Barts Cancer Institute / Barts Health NHS Trust](https://onco.cc/institutions/barts-cancer-institute/), [Breast Cancer Now](https://onco.cc/institutions/breast-cancer-now/), [Breast Cancer Research Foundation](https://onco.cc/institutions/bcrf/), [Cleveland Clinic Taussig Cancer Institute](https://onco.cc/institutions/cleveland-clinic/), [Dana-Farber Brigham Cancer Center](https://onco.cc/institutions/dana-farber/), [Fudan University Shanghai Cancer Center](https://onco.cc/institutions/fuscc/), [Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre](https://onco.cc/institutions/guys-st-thomas/), [Hospital General Universitario Gregorio Marañón](https://onco.cc/institutions/gregorio-maranon/), [IEO (European Institute of Oncology)](https://onco.cc/institutions/ieo-milan/), [Indiana University Melvin and Bren Simon Comprehensive Cancer Center](https://onco.cc/institutions/iu-simon/), [Institut Curie](https://onco.cc/institutions/institut-curie/), [Institut Jules Bordet](https://onco.cc/institutions/institut-jules-bordet/), [Institut Paoli-Calmettes](https://onco.cc/institutions/institut-paoli-calmettes/), [Korle Bu Teaching Hospital](https://onco.cc/institutions/korle-bu-teaching-hospital/), [Lagos University Teaching Hospital](https://onco.cc/institutions/luth-lagos/), [Mays Cancer Center at UT Health San Antonio](https://onco.cc/institutions/mays-cancer-center/), [Salk Institute Cancer Center](https://onco.cc/institutions/salk-institute/), [Skåne University Hospital / Lund University Cancer Centre](https://onco.cc/institutions/lund-skane/), [The Christie NHS Foundation Trust](https://onco.cc/institutions/the-christie/), [The Royal Marsden](https://onco.cc/institutions/royal-marsden/), [The University of Kansas Cancer Center](https://onco.cc/institutions/ku-cancer-center/), [Tianjin Medical University Cancer Institute and Hospital](https://onco.cc/institutions/tmucih/), [UNC Lineberger Comprehensive Cancer Center](https://onco.cc/institutions/unc-lineberger/), [University Hospital Southampton / Centre for Cancer Immunology](https://onco.cc/institutions/southampton-cancer/), [University of Malaya Medical Centre](https://onco.cc/institutions/ummc-kuala-lumpur/), [Vanderbilt-Ingram Cancer Center](https://onco.cc/institutions/vanderbilt-ingram/)
- pathways: [Androgen receptor signalling](https://onco.cc/pathways/ar-signaling/), [Antigen presentation & immune editing](https://onco.cc/pathways/antigen-presentation-immunoediting/), [Base excision repair, PARP & alkylation damage](https://onco.cc/pathways/base-excision-repair-parp/), [Breast cancer (KEGG map)](https://onco.cc/pathways/breast-cancer-signalling/), [DNA damage response & homologous recombination](https://onco.cc/pathways/ddr/), [Double-strand break repair: HR versus end joining](https://onco.cc/pathways/homologous-recombination-repair/), [Epithelial-mesenchymal transition & drug efflux](https://onco.cc/pathways/emt/), [Mismatch repair & microsatellite instability](https://onco.cc/pathways/mismatch-repair-msi/), [Mutagenesis & mutational signatures](https://onco.cc/pathways/mutagenesis-signatures/), [MYC](https://onco.cc/pathways/myc/), [Notch signalling](https://onco.cc/pathways/notch/), [p53 / RB / cell-cycle checkpoint](https://onco.cc/pathways/p53-cell-cycle/), [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/), [PI3K / AKT / mTOR](https://onco.cc/pathways/pi3k-akt-mtor/), [Receptor tyrosine kinase activation](https://onco.cc/pathways/rtk-activation/)
- terms: [ADC sequencing](https://onco.cc/terms/adc-sequencing/), [AJCC 8th edition prognostic stage for breast cancer](https://onco.cc/terms/ajcc-prognostic-stage-breast/), [Androgen receptor-positive triple-negative breast cancer](https://onco.cc/terms/androgen-receptor-positive-tnbc/), [Anthracyclines (doxorubicin, epirubicin)](https://onco.cc/terms/anthracycline/), [Basal-like breast cancer](https://onco.cc/terms/basal-like/), [Body image after breast surgery and reconstruction](https://onco.cc/terms/body-image-after-breast-surgery/), [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [BRCA reversion mutations](https://onco.cc/terms/brca-reversion-mutations/), [Cancer health disparities and equity](https://onco.cc/terms/cancer-health-disparities/), [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/), [Cardiotoxicity (LVEF decline, cardiomyopathy)](https://onco.cc/terms/cardiotoxicity/), [Carers: what you can do and UK carer support (breast cancer)](https://onco.cc/terms/carers-breast-cancer-uk/), [Chemoprevention (tamoxifen, anastrozole, raloxifene) and ER-negative breast cancer](https://onco.cc/terms/chemoprevention-and-er-negative-breast-cancer/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Claudin-low breast cancer](https://onco.cc/terms/claudin-low/), [Clinical trial](https://onco.cc/terms/clinical-trial/), [Combined positive score (CPS)](https://onco.cc/terms/cps/), [De-escalation, escalation and response-adapted therapy](https://onco.cc/terms/de-escalation/), [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/), [Dose-dense and metronomic chemotherapy](https://onco.cc/terms/dose-dense-chemotherapy/), [Emotional support and helplines (UK)](https://onco.cc/terms/emotional-support-cancer-uk/), [ER and PR negative under 1 percent (the triple-negative threshold, and ER-low)](https://onco.cc/terms/er-pr-negative-threshold/), [Exceptional responder](https://onco.cc/terms/exceptional-responder/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Financial toxicity](https://onco.cc/terms/financial-toxicity/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [Founder mutation (BRCA1 185delAG and 5382insC, BRCA2 6174delT)](https://onco.cc/terms/founder-mutation/), [Gene amplification and copy-number change](https://onco.cc/terms/gene-amplification/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Germline BRCA testing criteria for triple-negative breast cancer (UK)](https://onco.cc/terms/germline-brca-testing-criteria-tnbc/), [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/), [Grade](https://onco.cc/terms/tumour-grade/), [Hair loss and scalp cooling with breast cancer chemotherapy](https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/), [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/), [Health disparities in cancer outcomes (ethnicity, deprivation and access)](https://onco.cc/terms/health-disparities/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/), [HER2-low eligibility for trastuzumab deruxtecan, and TROP2 ADCs without a test (triple-negative disease)](https://onco.cc/terms/her2-low-and-trop2-adc-eligibility-tnbc/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/), [Homologous recombination deficiency (HRD) in breast cancer](https://onco.cc/terms/hrd-in-breast-cancer/), [Hormone receptor status (ER / PR)](https://onco.cc/terms/hormone-receptor-status/), [Immune-mediated colitis and diarrhoea](https://onco.cc/terms/immune-colitis/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Informed consent](https://onco.cc/terms/informed-consent/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/), [Interval breast cancer (a cancer found between screening rounds)](https://onco.cc/terms/interval-breast-cancer/), [Invasive disease-free survival (iDFS)](https://onco.cc/terms/idfs/), [Ki-67 in triple-negative breast cancer](https://onco.cc/terms/ki-67-in-tnbc/), [Living with an antibody-drug conjugate: diarrhoea, blood counts, eyes and lungs](https://onco.cc/terms/adc-side-effects-breast/), [Luminal androgen receptor (LAR) subtype](https://onco.cc/terms/luminal-androgen-receptor/), [Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Mastectomy](https://onco.cc/terms/mastectomy/), [Menopause symptoms after chemotherapy for breast cancer](https://onco.cc/terms/menopause-after-chemotherapy-breast/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Mutational signature](https://onco.cc/terms/mutational-signature/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Neutropenia](https://onco.cc/terms/neutropenia/), [Neutropenic sepsis: the temperature rule and the 999 signs](https://onco.cc/terms/neutropenic-sepsis-breast-chemotherapy/), [Next-generation sequencing (NGS)](https://onco.cc/terms/ngs/), [Ocular toxicity (keratopathy, blurred vision)](https://onco.cc/terms/ocular-toxicity/), [Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life](https://onco.cc/terms/tnbc-symptom-control-palliation/), [PAM50 / intrinsic subtypes](https://onco.cc/terms/pam50/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [PD-L1 assay discordance (SP142, SP263 and 22C3 in breast cancer)](https://onco.cc/terms/pd-l1-assay-discordance/), [PD-L1 combined positive score 10 in triple-negative breast cancer](https://onco.cc/terms/pd-l1-cps-10-tnbc/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [Placebo](https://onco.cc/terms/placebo/), [Radiation dermatitis (skin reaction)](https://onco.cc/terms/radiation-dermatitis/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/), [Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point](https://onco.cc/terms/tnbc-residual-disease-decision/), [Risk-reducing surgery for BRCA carriers (bilateral and contralateral mastectomy, salpingo-oophorectomy)](https://onco.cc/terms/risk-reducing-surgery-brca-carriers/), [Sentinel node biopsy](https://onco.cc/terms/sentinel-lymph-node-biopsy/), [Stereotactic radiosurgery (SRS)](https://onco.cc/terms/stereotactic-radiosurgery/), [Synthetic lethality](https://onco.cc/terms/synthetic-lethality/), [TNM staging](https://onco.cc/terms/tnm-staging/), [Triple-negative breast cancer trials open today (registry snapshot and UK sites)](https://onco.cc/terms/tnbc-trials-open-today/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Tumour proportion score (TPS)](https://onco.cc/terms/tps/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/), [Tumour-infiltrating lymphocytes (TILs)](https://onco.cc/terms/tils/), [Tumour-informed versus tumour-naive ctDNA assays](https://onco.cc/terms/tumour-informed-assay/), [Variant of uncertain significance (VUS)](https://onco.cc/terms/vus/), [When to seek urgent help with triple-negative breast cancer (NHS 111 and 999)](https://onco.cc/terms/urgent-help-tnbc/), [Whole-brain radiotherapy (WBRT)](https://onco.cc/terms/wbrt/), [Work and money during breast cancer treatment (UK)](https://onco.cc/terms/work-and-money-breast-cancer-uk/)
- trials: [A Clinical Study of 9MW2821 (and PD-1 Inhibitor) in Locally Advanced or Metastatic Triple-Negative Breast Cancer](https://onco.cc/trials/nct06492005/), [A Clinical Study of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) in People With Breast Cancer (MK-2870-032)](https://onco.cc/trials/nct06966700/), [A Clinical Trial of SHR-A1811 in the Treatment of Triple-negative Breast Cancer](https://onco.cc/trials/nct07111832/), [A Phase 2 Study of PCS6422 With Capecitabine in Patients With Advanced or Metastatic Breast Cancer](https://onco.cc/trials/nct06568692/), [A Phase I/II Study of VLS-1488 in Subjects With Advanced Cancer](https://onco.cc/trials/nct05902988/), [A Phase III Randomised Study to Evaluate Dato-DXd and Durvalumab for Neoadjuvant/Adjuvant Treatment of Triple-Negative or Hormone Receptor-low/HER2-negative Breast Cancer](https://onco.cc/trials/nct06112379/), [A Phase III Study of ESG401 for Unresectable Recurrent or Metastatic Triple-Negative Breast Cancer](https://onco.cc/trials/nct06732323/), [A Phase III Study of JSKN016 Versus Treatment of Physician's Choice in Patients With Triple-Negative Breast Cancer Who Have Failed Standard of Care](https://onco.cc/trials/nct07533123/), [A Study of AK117/AK112 in Metastatic Triple-Negative Breast Cancer](https://onco.cc/trials/nct05227664/), [A Study of BEBT-209 Plus Chemotherapy in Patients With Locally Advanced or Metastatic Triple-Negative Breast Cancer](https://onco.cc/trials/nct07544056/), [A Study of BL-B01D1+PD-1 Monoclonal Antibody in Patients With Unresectable Locally Advanced or Recurrent Metastatic Triple-negative Breast Cancer](https://onco.cc/trials/nct06471205/), [A Study of Dato-DXd in Chinese Patients With Advanced Non-Small Cell Lung Cancer, Triple-negative Breast Cancer and Other Solid Tumors (TROPION-PanTumor02)](https://onco.cc/trials/nct05460273/), [A Study of Disitamab Vedotin With Other Anticancer Drugs in Solid Tumors](https://onco.cc/trials/nct06157892/), [A Study of Emiltatug Ledadotin (Emi-Le) in Participants With Solid Tumors](https://onco.cc/trials/nct05377996/), [A Study of MR001 in Patients With Locally Recurrent or Metastatic Advanced Triple-Negative Breast Cancer (TNBC)](https://onco.cc/trials/nct07208149/), [A Study of Novel Anti-cancer Agents in Patients With Metastatic Triple Negative Breast Cancer](https://onco.cc/trials/nct03742102/), [A Study of PM8002 Plus Nab-paclitaxel as First Line Therapy for TNBC](https://onco.cc/trials/nct05918133/), [A Study of Sacituzumab Govitecan Given at an Alternative Dose and Schedule in Participants With Advanced Triple-Negative Breast Cancer](https://onco.cc/trials/nct06926920/), [A Study of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) as Monotherapy and in Combination With Pembrolizumab (MK-3475) in Participants With Triple-Negative Breast Cancer (MK-2870-011/TroFuse-011)](https://onco.cc/trials/nct06841354/), [A Study of SKB264 Versus Investigator's Choice Chemotherapy in Patients With Unresectable Recurrent or Metastatic Triple-Negative Breast Cancer](https://onco.cc/trials/nct06279364/), [A Study of Tobemstomig + Nab-Paclitaxel Compared With Pembrolizumab + Nab-Paclitaxel in Participants With Previously Untreated, PD-L1-Positive, Locally-Advanced Unresectable or Metastatic Triple-Negative Breast Cancer](https://onco.cc/trials/nct05852691/), [A Study of Trastuzumab Rezetecan in Combination With Adebrelimab Versus Investigator's Choice of Therapy in Subjects With Residual Triple Negative Breast Cancer](https://onco.cc/trials/nct07679360/), [A Study to Assess Safety, Tolerability and Imaging Characteristics of [68Ga]Ga-DPI-4452 and to Assess Safety, Tolerability, and Efficacy of [177Lu]Lu-DPI-4452 in Participants With Unresectable Locally Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct05706129/), [A Study to Evaluate the Efficacy and Safety of Nanosomal Docetaxel Lipid Suspension in Triple Negative Breast Cancer Patients](https://onco.cc/trials/nct03671044/), [A Study to Evaluate the Safety and Efficacy of A2B395, an Allogeneic Logic-gated CAR T, in Participants With Solid Tumors That Express EGFR and Have Lost HLA-A*02 Expression](https://onco.cc/trials/nct06682793/), [A Trial of LBL-024 Monotherapy or Combination Drug in Patients With Triple Negative Breast Cancer](https://onco.cc/trials/nct07281976/), [A-BRAVE](https://onco.cc/trials/a-brave/), [AK112 or Placebo Plus Nab-Paclitaxel as First-line Treatment in Inoperable Locally Advanced/ Metastatic Triple-negative Breast Cancer](https://onco.cc/trials/nct06767527/), [ALEXANDRA / IMpassion030](https://onco.cc/trials/impassion030/), [ASCENT](https://onco.cc/trials/ascent/), [ASCENT-03](https://onco.cc/trials/ascent-03/), [ASCENT-04 / KEYNOTE-D19](https://onco.cc/trials/ascent-04/), [ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)](https://onco.cc/trials/ascent-05/), [BARBICAN](https://onco.cc/trials/barbican/), [BCD-236 in Combination With Chemotherapy in Patients With Relapsed and/or Metastatic Triple Negative Breast Cancer](https://onco.cc/trials/nct07108309/), [BL-B01D1-307](https://onco.cc/trials/bl-b01d1-307/), [BRE12-158 (Hoosier Oncology Group)](https://onco.cc/trials/bre12-158/), [BrighTNess](https://onco.cc/trials/brightness/), [BROCADE3](https://onco.cc/trials/brocade3/), [c-TRAK TN](https://onco.cc/trials/c-trak-tn/), [CALGB 40603 (Alliance)](https://onco.cc/trials/calgb-40603/), [Capivasertib+Paclitaxel as First Line Treatment for Patients With Locally Advanced or Metastatic TNBC](https://onco.cc/trials/nct03997123/), [CREATE-X](https://onco.cc/trials/create-x/), [DBCG 82b and 82c](https://onco.cc/trials/dbcg-82bc/), [DESTINY-Breast04](https://onco.cc/trials/destiny-breast04/), [DESTINY-Breast06](https://onco.cc/trials/destiny-breast06/), [DIAMOND](https://onco.cc/trials/diamond/), [Dual-Target CAR-NK Cells for Advanced Breast Cancer (HER2+ and TNBC)](https://onco.cc/trials/nct07486089/), [Dual-Target CAR-NK Cells for Advanced Breast Cancer HER2+ TNBC](https://onco.cc/trials/nct07510802/), [ECOG-ACRIN EA1131](https://onco.cc/trials/ea1131/), [Efficacy and Safety Comparison of Niraparib to Placebo in Participants With Human Epidermal Growth Factor 2 Negative (HER2-) Breast Cancer Susceptibility Gene Mutation (BRCAmut) or Triple-Negative Breast Cancer (TNBC) With Molecular Disease](https://onco.cc/trials/nct04915755/), [Efficacy and Safety of Tenalisib in Patients With Metastatic Triple Negative Breast Cancer (TNBC)](https://onco.cc/trials/nct06189209/), [EMBRACA](https://onco.cc/trials/embraca/), [EORTC 22922/10925](https://onco.cc/trials/eortc-22922/), [FAST-Forward](https://onco.cc/trials/fast-forward/), [FDA018-ADC vs Investigator's Choice Chemotherapy to Treat Locally Advanced, Recurrent or Metastatic Triple-negative Breast Cancer](https://onco.cc/trials/nct06519370/), [First in Human Study of TUB-030 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06657222/), [GEICAM/2003-11_CIBOMA/2004-01](https://onco.cc/trials/geicam-ciboma/), [GeparDouze / NSABP B-59](https://onco.cc/trials/gepardouze/), [GeparSixto](https://onco.cc/trials/geparsixto/), [I-SPY 1 (CALGB 150007/150012, ACRIN 6657)](https://onco.cc/trials/i-spy-1/), [I-SPY 2](https://onco.cc/trials/i-spy-2/), [I-SPY 2.2](https://onco.cc/trials/i-spy-2-2/), [IMpassion031](https://onco.cc/trials/impassion031/), [IMpassion130](https://onco.cc/trials/impassion130/), [IMpassion131](https://onco.cc/trials/impassion131/), [IMPORT LOW](https://onco.cc/trials/import-low/), [INSITE](https://onco.cc/trials/insite/), [IPATunity130](https://onco.cc/trials/ipatunity130/), [Ivermectin with balstilimab or pembrolizumab in metastatic triple-negative breast cancer (Cedars-Sinai phase 1/2)](https://onco.cc/trials/nct05318469/), [IZABRIGHT-Breast01](https://onco.cc/trials/izabright-breast01/), [JAB-2485 Activity in Adult Patients With Advanced Solid Tumors](https://onco.cc/trials/nct05490472/), [KEYNOTE-119](https://onco.cc/trials/keynote-119/), [KEYNOTE-355](https://onco.cc/trials/keynote-355/), [KEYNOTE-522](https://onco.cc/trials/keynote-522/), [LOTUS](https://onco.cc/trials/lotus/), [MASAI (Mammography Screening with Artificial Intelligence)](https://onco.cc/trials/masai/), [Modi-1 Moditope in Breast, Head and Neck, Ovarian, or Renal Cancer](https://onco.cc/trials/nct05329532/), [NCIC MA.20](https://onco.cc/trials/ma-20/), [NeoPACT](https://onco.cc/trials/neopact/), [NeoTRIP (NeoTRIPaPDL1)](https://onco.cc/trials/neotrip/), [NSABP B-39/RTOG 0413](https://onco.cc/trials/nsabp-b39/), [Nuvastatic® Phase III Trial for Fatigue in Triple-Negative Breast Cancer](https://onco.cc/trials/nct07669467/), [OlympiA](https://onco.cc/trials/olympia/), [OlympiAD](https://onco.cc/trials/olympiad/), [OptimICE-pCR (A012103)](https://onco.cc/trials/optimice-pcr/), [PAKT](https://onco.cc/trials/pakt/), [PARTNER](https://onco.cc/trials/partner/), [Peritumoral lidocaine before breast cancer surgery (Tata Memorial)](https://onco.cc/trials/lidocaine-peritumoral-tmh/), [Personalised Neoantigen-targeting Cancer Vaccine NECVAX-NEO1 in Neoadjuvant Triple-negative Breast Cancer](https://onco.cc/trials/nct06631092/), [PHOENIX DDR/Anti-PD-L1](https://onco.cc/trials/phoenix/), [plasmaMATCH](https://onco.cc/trials/plasmamatch/), [PM8002 or Placebo Plus Nab-Paclitaxel as First-line Treatment in Inoperable Locally Advanced/Metastatic TNBC](https://onco.cc/trials/nct06419621/), [ProAgio in Combination With Gemcitabine in Patients With Metastatic Triple Negative Breast Cancer](https://onco.cc/trials/nct06460298/), [RADCOMP](https://onco.cc/trials/radcomp/), [Reverse Triple Negative Immune Resistant Breast Cancer](https://onco.cc/trials/nct05076682/), [ROSETTA Breast-01: The Effects and Safety of Pumitamig in Patients With Triple-Negative Breast Cancer](https://onco.cc/trials/nct07173751/), [Sacituzumab Tirumotecan (MK-2870) Plus Pembrolizumab Versus TPC in TNBC Who Did Not Achieve pCR (MK-2870-012)](https://onco.cc/trials/nct06393374/), [Safety and Preliminary Effectiveness of BNT327, an Investigational Therapy for Breast Cancer, When Given in Combination With Chemotherapy](https://onco.cc/trials/nct06449222/), [SCAN-B (Sweden Cancerome Analysis Network - Breast)](https://onco.cc/trials/scan-b/), [SCARLET (SWOG S2212)](https://onco.cc/trials/scarlet-s2212/), [ScreenTrustCAD](https://onco.cc/trials/screentrustcad/), [Single-injection depot progesterone before breast surgery (Tata Memorial)](https://onco.cc/trials/progesterone-preop-tmh/), [SKB264 Injection vs Investigator Selected Regimens to Treat Locally Advanced, Recurrent or Metastatic Triple-negative Breast Cancer](https://onco.cc/trials/nct05347134/), [START-B (UK Standardisation of Breast Radiotherapy)](https://onco.cc/trials/start-b/), [Study BT8009-100 in Subjects With Nectin-4 Expressing Advanced Malignancies](https://onco.cc/trials/nct04561362/), [Study of Adagloxad Simolenin (OBI-822)/OBI-821 in the Adjuvant Treatment of Patients With Globo H Positive TNBC](https://onco.cc/trials/nct03562637/), [Study of LP-184 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct05933265/), [Study of Sacituzumab Govitecan (SG) in Japanese Participants With Advanced Solid Tumors](https://onco.cc/trials/nct05101096/), [Study of Sacituzumab Govitecan in Chinese Patients With Metastatic Triple-negative Breast Cancer Who Received at Least Two Prior Treatments](https://onco.cc/trials/nct04454437/), [Study to Assess GTAEXS617 in Participants With Advanced Solid Tumors](https://onco.cc/trials/nct05985655/), [SWOG S1418 / NRG BR006](https://onco.cc/trials/swog-s1418/), [SYSUCC-001](https://onco.cc/trials/sysucc-001/), [TMIST (Tomosynthesis Mammographic Imaging Screening Trial)](https://onco.cc/trials/tmist/), [TNT (Triple Negative Trial)](https://onco.cc/trials/tnt/), [To Assess Safety and Efficacy of Agents Targeting DNA Damage Repair With Olaparib Versus Olaparib Monotherapy.](https://onco.cc/trials/nct03330847/), [TROPION-Breast02](https://onco.cc/trials/tropion-breast02/), [TROPION-Breast03](https://onco.cc/trials/tropion-breast03/), [TROPION-Breast05](https://onco.cc/trials/tropion-breast05/), [WHEL (Women's Healthy Eating and Living)](https://onco.cc/trials/whel/)
- people: [Aditya Bardia](https://onco.cc/people/aditya-bardia/), [Alan Ashworth](https://onco.cc/people/alan-ashworth/), [Andrew Tutt](https://onco.cc/people/andrew-tutt/), [Angela DeMichele](https://onco.cc/people/angela-demichele/), [Angelina Jolie](https://onco.cc/people/angelina-jolie/), [Anne Armstrong](https://onco.cc/people/anne-armstrong/), [Binghe Xu](https://onco.cc/people/xu-binghe/), [Carlos Caldas](https://onco.cc/people/carlos-caldas/), [Carsten Denkert](https://onco.cc/people/carsten-denkert/), [Charles E. Geyer Jr.](https://onco.cc/people/charles-geyer/), [Charles M. Perou](https://onco.cc/people/charles-perou/), [Dawn L. Hershman](https://onco.cc/people/dawn-hershman/), [Debu Tripathy](https://onco.cc/people/debu-tripathy/), [Derrick S. Haslem](https://onco.cc/people/derrick-haslem/), [Donna McKay](https://onco.cc/people/donna-mckay/), [Dorraya El-Ashry](https://onco.cc/people/dorraya-el-ashry/), [Elizabeth A. Mittendorf](https://onco.cc/people/elizabeth-mittendorf/), [Ellen Copson](https://onco.cc/people/ellen-copson/), [Eric P. Winer](https://onco.cc/people/eric-winer/), [Giovanni Blandino](https://onco.cc/people/giovanni-blandino/), [Giuseppe Curigliano](https://onco.cc/people/giuseppe-curigliano/), [Hatem Soliman](https://onco.cc/people/hatem-soliman/), [Hope S. Rugo](https://onco.cc/people/hope-rugo/), [Isabel T. Rubio](https://onco.cc/people/isabel-rubio/), [Jean Abraham](https://onco.cc/people/jean-abraham/), [Jennifer K. Litton](https://onco.cc/people/jennifer-litton/), [Judy E. Garber](https://onco.cc/people/judy-garber/), [Lajos Pusztai](https://onco.cc/people/lajos-pusztai/), [Laura J. Esserman](https://onco.cc/people/laura-esserman/), [Leif W. Ellisen](https://onco.cc/people/leif-ellisen/), [Lori J. Pierce](https://onco.cc/people/lori-pierce/), [Mariana Chavez-MacGregor](https://onco.cc/people/mariana-chavez-macgregor/), [Mary-Claire King](https://onco.cc/people/mary-claire-king/), [Max S. Wicha](https://onco.cc/people/max-wicha/), [Miguel Martín](https://onco.cc/people/miguel-martin/), [Mitchell D. Schnall](https://onco.cc/people/mitchell-schnall/), [Monica Morrow](https://onco.cc/people/monica-morrow/), [Nikolaus Rajewsky](https://onco.cc/people/nikolaus-rajewsky/), [Paolo Veronesi](https://onco.cc/people/paolo-veronesi/), [Peter Schmid](https://onco.cc/people/peter-schmid/), [Priya Rastogi](https://onco.cc/people/priya-rastogi/), [Priyanka Sharma](https://onco.cc/people/priyanka-sharma/), [Rajendra Badwe](https://onco.cc/people/badwe-rajendra/), [Rebecca Dent](https://onco.cc/people/rebecca-dent/), [Rita Schmutzler](https://onco.cc/people/rita-schmutzler/), [Sabine Linn](https://onco.cc/people/sabine-linn/), [Sandra Demaria](https://onco.cc/people/sandra-demaria/), [Sara A. Hurvitz](https://onco.cc/people/sara-hurvitz/), [Sara López-Tarruella](https://onco.cc/people/sara-lopez-tarruella/), [Sara M. Tolaney](https://onco.cc/people/sara-tolaney/), [Seock-Ah Im](https://onco.cc/people/im-seock-ah/), [Serena Nik-Zainal](https://onco.cc/people/serena-nik-zainal/), [Shanu Modi](https://onco.cc/people/shanu-modi/), [Shaoli Song](https://onco.cc/people/song-shaoli/), [Sherene Loi](https://onco.cc/people/loi-sherene/), [Sibylle Loibl](https://onco.cc/people/sibylle-loibl/), [Sudeep Gupta](https://onco.cc/people/gupta-sudeep/), [Sung-Bae Kim](https://onco.cc/people/kim-sung-bae/), [Sunil Lakhani](https://onco.cc/people/sunil-lakhani/), [Susan M. Domchek](https://onco.cc/people/susan-domchek/), [Suzette Delaloge](https://onco.cc/people/suzette-delaloge/), [Takayuki Ueno](https://onco.cc/people/ueno-takayuki/), [Timothy J. Eberlein](https://onco.cc/people/timothy-eberlein/), [Vincent K. Tuohy](https://onco.cc/people/vincent-tuohy/), [Xichun Hu](https://onco.cc/people/hu-xichun/), [Yi-Zhou Jiang](https://onco.cc/people/jiang-yi-zhou/), [Zhi-Ming Shao](https://onco.cc/people/shao-zhi-ming/)
- key papers: [A high prevalence of BRCA1 mutations among breast cancer patients from the Bahamas](https://onco.cc/key-papers/paper-donenberg-bahamas-brca1-founder-bcrt-2011/), [Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy](https://onco.cc/key-papers/paper-create-x-adjuvant-capecitabine-nejm-2017/), [African ancestry-associated gene expression profiles in triple-negative breast cancer underlie altered tumor biology and clinical outcome in women of African descent](https://onco.cc/key-papers/paper-martini-african-ancestry-tnbc-cancer-discov-2022/), [Al-Hajj 2003: prospective identification of tumorigenic breast cancer cells](https://onco.cc/key-papers/paper-al-hajj-breast-cancer-stem-cells-pnas-2003/), [American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer](https://onco.cc/key-papers/paper-asco-cap-er-pr-testing-guideline-jco-2010/), [Artificial intelligence for breast cancer detection in screening mammography in Sweden: a prospective, population-based, paired-reader, non-inferiority study (ScreenTrustCAD)](https://onco.cc/key-papers/paper-screentrustcad-dembrower-lancet-digit-health-2023/), [ASCENT: sacituzumab govitecan doubles survival in heavily pretreated metastatic triple-negative breast cancer](https://onco.cc/key-papers/paper-ascent-nejm-2021/), [Assessment of molecular relapse detection in early-stage breast cancer](https://onco.cc/key-papers/paper-garcia-murillas-molecular-relapse-detection-jama-oncol-2019/), [Association of Circulating Tumor DNA and Circulating Tumor Cells After Neoadjuvant Chemotherapy With Disease Recurrence in Patients With Triple-Negative Breast Cancer: Preplanned Secondary Analysis of the BRE12-158 Randomized Clinical Trial](https://onco.cc/key-papers/paper-radovich-ctdna-ctc-bre12-158-jama-oncol-2020/), [Biomarker analyses in the phase III ASCENT study of sacituzumab govitecan versus chemotherapy in patients with metastatic triple-negative breast cancer](https://onco.cc/key-papers/paper-bardia-ascent-trop2-biomarker-ann-oncol-2021/), [Biomarkers for Systemic Therapy in Metastatic Breast Cancer: ASCO Guideline Update](https://onco.cc/key-papers/paper-asco-biomarkers-metastatic-breast-cancer-guideline-jco-2022/), [Breast Cancer, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology](https://onco.cc/key-papers/paper-nccn-breast-cancer-v4-2026-jnccn-2026/), [c-TRAK TN analysis: tissue-free versus tumour-informed ctDNA assays for residual disease in early triple-negative breast cancer](https://onco.cc/key-papers/paper-ctrak-tn-tissue-free-mrd-jamaoncol-2026/), [Capivasertib plus paclitaxel as first-line treatment for metastatic triple-negative breast cancer: results from the randomised, global phase III CAPItello-290 trial](https://onco.cc/key-papers/paper-capitello-290-capivasertib-paclitaxel-ann-oncol-2026/), [Capivasertib plus paclitaxel versus placebo plus paclitaxel as first-line therapy for metastatic triple-negative breast cancer: the PAKT trial](https://onco.cc/key-papers/paper-schmid-pakt-capivasertib-tnbc-jco-2020/), [Carboplatin in BRCA1/2-mutated and triple-negative breast cancer BRCAness subgroups: the TNT Trial](https://onco.cc/key-papers/paper-tutt-nat-med/), [Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival](https://onco.cc/key-papers/paper-magbanua-ispy2-ctdna-neoadjuvant-ann-oncol-2021/), [Clinical and molecular characteristics of HER2-low-positive breast cancer: pooled analysis of individual patient data from four prospective, neoadjuvant clinical trials](https://onco.cc/key-papers/paper-denkert-her2-low-pooled-neoadjuvant-lancet-oncol-2021/), [Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer](https://onco.cc/key-papers/paper-atchley-brca-status-triple-negative-jco-2008/), [Clinical, pathological, and PAM50 gene expression features of HER2-low breast cancer](https://onco.cc/key-papers/paper-schettini-her2-low-features-npj-breast-cancer-2021/), [Comparison of breast cancer molecular features and survival by African and European ancestry in The Cancer Genome Atlas](https://onco.cc/key-papers/paper-huo-tcga-ancestry-breast-jama-oncol-2017/), [Comparison of SP142 and 22C3 PD-L1 assays in a population-based cohort of triple-negative breast cancer patients in the context of their clinically established scoring algorithms](https://onco.cc/key-papers/paper-sigurjonsdottir-sp142-22c3-tnbc-bcr-2023/), [Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials](https://onco.cc/key-papers/paper-ebctcg-polychemotherapy-regimens-meta-analysis-lancet-2012/), [Comprehensive genomic analysis identifies novel subtypes and targets of triple-negative breast cancer](https://onco.cc/key-papers/paper-burstein-tnbc-genomic-subtypes-ccr-2015/), [Comprehensive molecular portraits of human breast tumours](https://onco.cc/key-papers/paper-tcga-breast-molecular-portraits-nature-2012/), [ctDNA and residual cancer burden are prognostic in triple-negative breast cancer patients with residual disease](https://onco.cc/key-papers/paper-stecklein-ctdna-rcb-tnbc-residual-disease-npj-2023/), [Datopotamab deruxtecan in patients with untreated, advanced triple-negative breast cancer (TROPION-Breast02): a randomised, open-label, international, phase III trial](https://onco.cc/key-papers/paper-tropion-breast02-ann-oncol-2026/), [Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry](https://onco.cc/key-papers/paper-bauer-triple-negative-california-registry-cancer-2007/), [DESTINY-Breast04: trastuzumab deruxtecan works in HER2-low breast cancer, creating a new treatable group](https://onco.cc/key-papers/paper-destiny-breast04-nejm-2022/), [Discovery of biomarkers predictive of GSI response in triple-negative breast cancer and adenoid cystic carcinoma](https://onco.cc/key-papers/paper-stoeck-notch-rearrangements-tnbc-cancer-discov-2014/), [Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-esmo-early-breast-cancer-guideline-ann-oncol-2024/), [Enzalutamide for the treatment of androgen receptor-expressing triple-negative breast cancer](https://onco.cc/key-papers/paper-traina-enzalutamide-ar-tnbc-jco-2018/), [ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer](https://onco.cc/key-papers/paper-esmo-metastatic-breast-cancer-guideline-ann-oncol-2021/), [Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study](https://onco.cc/key-papers/paper-copson-posh-ethnicity-young-breast-cancer-uk-bjc-2014/), [Exploring the spectrum of HER2 in non-metastatic triple negative breast cancer: from HER2-null to HER2-low, including HER2-ultralow status](https://onco.cc/key-papers/paper-boissiere-michot-her2-ultralow-tnbc-virchows-arch-2026/), [Founder mutations in the BRCA1 gene in Polish families with breast-ovarian cancer](https://onco.cc/key-papers/paper-gorski-brca1-founder-mutations-poland-ajhg-2000/), [Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications](https://onco.cc/key-papers/paper-sorlie-breast-carcinoma-subclasses-pnas-2001/), [Genomic and transcriptomic landscape of triple-negative breast cancers: subtypes and treatment strategies](https://onco.cc/key-papers/paper-jiang-fuscc-tnbc-landscape-cancer-cell-2019/), [Genomic characterization of metastatic breast cancers](https://onco.cc/key-papers/paper-bertucci-metastatic-breast-genomics-nature-2019/), [Germline BRCA mutation evaluation in a prospective triple-negative breast cancer registry: implications for hereditary breast and/or ovarian cancer syndrome testing](https://onco.cc/key-papers/paper-sharma-tnbc-registry-germline-brca-bcrt-2014/), [Germline BRCA1 mutations and a basal epithelial phenotype in breast cancer](https://onco.cc/key-papers/paper-foulkes-brca1-basal-phenotype-jnci-2003/), [Germline mutation status, pathological complete response, and disease-free survival in triple-negative breast cancer: secondary analysis of the GeparSixto randomized clinical trial](https://onco.cc/key-papers/paper-hahnen-geparsixto-germline-brca-jama-oncol-2017/), [Germline testing in patients with breast cancer: ASCO-Society of Surgical Oncology guideline](https://onco.cc/key-papers/paper-bedrosian-asco-sso-germline-testing-breast-jco-2024/), [Homologous recombination deficiency (HRD) score predicts response to platinum-containing neoadjuvant chemotherapy in patients with triple-negative breast cancer](https://onco.cc/key-papers/paper-telli-hrd-score-platinum-tnbc-ccr-2016/), [HRDetect is a predictor of BRCA1 and BRCA2 deficiency based on mutational signatures](https://onco.cc/key-papers/paper-davies-nat-med/), [Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies](https://onco.cc/key-papers/paper-lehmann-tnbc-subtypes-jci-2011/), [Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance)](https://onco.cc/key-papers/paper-sikov-calgb-40603-carboplatin-bevacizumab-jco-2015/), [Implementation and audit of mainstream genetic testing within a high-volume UK breast unit for pathogenic variations associated with breast cancer using the R208 and R444.1 National Test Directory criterion](https://onco.cc/key-papers/paper-conroy-nhs-r208-mainstream-testing-audit-breast-j-2026/), [Inherited breast cancer in Nigerian women](https://onco.cc/key-papers/paper-zheng-nigerian-inherited-breast-cancer-jco-2018/), [Inherited mutations in 17 breast cancer susceptibility genes among a large triple-negative breast cancer cohort unselected for family history of breast cancer](https://onco.cc/key-papers/paper-couch-tnbc-germline-17-genes-jco-2015/), [Ipatasertib plus paclitaxel versus placebo plus paclitaxel as first-line therapy for metastatic triple-negative breast cancer (LOTUS): a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial](https://onco.cc/key-papers/paper-kim-lotus-ipatasertib-tnbc-lancet-oncol-2017/), [Ivermectin converts cold tumors hot and synergizes with immune checkpoint blockade for treatment of breast cancer (with 2026 expression of concern)](https://onco.cc/key-papers/paper-draganov-ivermectin-cold-tumours-npj-breast-cancer-2021/), [KEYNOTE-522: adding pembrolizumab before and after surgery in early triple-negative breast cancer](https://onco.cc/key-papers/paper-keynote-522-nejm-2022/), [Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase III trial](https://onco.cc/key-papers/paper-geyer-brightness-4-year-follow-up-ann-oncol-2022/), [Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype](https://onco.cc/key-papers/paper-symmans-rcb-long-term-prognosis-subtype-jco-2017/), [Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline](https://onco.cc/key-papers/paper-asco-hereditary-breast-cancer-guideline-jco-2020/), [Mani 2008: the epithelial-mesenchymal transition generates cells with properties of stem cells](https://onco.cc/key-papers/paper-mani-emt-stem-cell-properties-cell-2008/), [MASAI: AI-supported mammography screening finds more cancers with half the radiologist workload](https://onco.cc/key-papers/paper-masai-lancet-oncol-2023/), [Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy](https://onco.cc/key-papers/paper-symmans-j-clin-oncol/), [Microsatellite instability in Japanese female patients with triple-negative breast cancer](https://onco.cc/key-papers/paper-kurata-japanese-tnbc-msi-breast-cancer-2020/), [Mismatch repair deficiency and microsatellite instability in triple-negative breast cancer: a retrospective study of 440 patients](https://onco.cc/key-papers/paper-ren-tnbc-mmr-msi-440-front-oncol-2021/), [Molecular portraits of human breast tumours](https://onco.cc/key-papers/paper-perou-molecular-portraits-breast-tumours-nature-2000/), [Multi-omics analysis identifies therapeutic vulnerabilities in triple-negative breast cancer subtypes](https://onco.cc/key-papers/paper-lehmann-tnbc-subtype-multiomics-nat-commun-2021/), [Mutation tracking in circulating tumor DNA predicts relapse in early breast cancer](https://onco.cc/key-papers/paper-garcia-murillas-ctdna-mutation-tracking-stm-2015/), [MYC pathway activation in triple-negative breast cancer is synthetic lethal with CDK inhibition](https://onco.cc/key-papers/paper-horiuchi-myc-tnbc-cdk-synthetic-lethal-jem-2012/), [Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline](https://onco.cc/key-papers/paper-asco-neoadjuvant-therapy-breast-guideline-jco-2021/), [OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer](https://onco.cc/key-papers/paper-olympia-nejm-2021/), [Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer](https://onco.cc/key-papers/paper-olympia-overall-survival-ann-oncol-2022/), [Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis](https://onco.cc/key-papers/paper-cortazar-ctneobc-pcr-pooled-analysis-lancet-2014/), [PD-L1 Immunohistochemistry Assay Comparison in Atezolizumab Plus nab-Paclitaxel-Treated Advanced Triple-Negative Breast Cancer](https://onco.cc/key-papers/paper-rugo-pd-l1-assay-comparison-impassion130-jnci-2021/), [PEST domain mutations in Notch receptors comprise an oncogenic driver segment in triple-negative breast cancer sensitive to a gamma-secretase inhibitor](https://onco.cc/key-papers/paper-wang-notch-pest-mutations-tnbc-ccr-2015/), [Phase II trial of bicalutamide in patients with androgen receptor-positive, estrogen receptor-negative metastatic breast cancer](https://onco.cc/key-papers/paper-gucalp-bicalutamide-ar-positive-tbcrc011-ccr-2013/), [Prevalence and mutational determinants of high tumor mutation burden in breast cancer](https://onco.cc/key-papers/paper-barroso-sousa-breast-tmb-prevalence-ann-oncol-2020/), [Prognostic and predictive value of circulating tumor DNA during neoadjuvant chemotherapy for triple negative breast cancer](https://onco.cc/key-papers/paper-cavallone-tnbc-ctdna-neoadjuvant-sci-rep-2020/), [Prognostic value of tumor-infiltrating lymphocytes in patients with early-stage triple-negative breast cancers (TNBC) who did not receive adjuvant chemotherapy](https://onco.cc/key-papers/paper-park-tils-untreated-early-tnbc-ann-oncol-2019/), [PROSE consortium: preventive surgery lowers cancer and death in BRCA1 and BRCA2 carriers](https://onco.cc/key-papers/paper-brca-risk-reducing-surgery-jama-2010/), [Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study](https://onco.cc/key-papers/paper-carey-race-breast-cancer-subtypes-cbcs-jama-2006/), [Refinement of Triple-Negative Breast Cancer Molecular Subtypes: Implications for Neoadjuvant Chemotherapy Selection](https://onco.cc/key-papers/paper-lehmann-tnbctype-4-refinement-plos-one-2016/), [Repeated observation of breast tumor subtypes in independent gene expression data sets](https://onco.cc/key-papers/paper-sorlie-repeated-observation-subtypes-brca1-basal-pnas-2003/), [Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients](https://onco.cc/key-papers/paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022/), [Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer](https://onco.cc/key-papers/paper-liedtke-neoadjuvant-response-survival-tnbc-jco-2008/), [Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer](https://onco.cc/key-papers/paper-turner-c-trak-tn-ctdna-pembrolizumab-ann-oncol-2023/), [SCALP: scalp cooling to prevent hair loss during chemotherapy for early breast cancer](https://onco.cc/key-papers/paper-scalp-trial-jama-2017/), [Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases](https://onco.cc/key-papers/paper-lin-tnbc-cns-metastases-dfci-cancer-2008/), [Slamon 1987: HER2 gene amplification marks an aggressive form of breast cancer](https://onco.cc/key-papers/paper-slamon-her2-amplification-science-1987/), [Spatially distinct tumor immune microenvironments stratify triple-negative breast cancers](https://onco.cc/key-papers/paper-gruosso-tnbc-spatial-immune-microenvironments-jci-2019/), [Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto](https://onco.cc/key-papers/paper-loibl-geparsixto-survival-hrd-ann-oncol-2018/), [Sustained benefit of adjuvant olaparib in women with germline BRCA1- and BRCA2-associated high-risk HER2-negative early breast cancer: updated results from the OlympiA phase III trial](https://onco.cc/key-papers/paper-olympia-6-year-update-ann-oncol-2026/), [Tailoring treatment to cancer risk and patient preference: the 2025 St Gallen International Breast Cancer Consensus Statement on individualizing therapy for patients with early breast cancer](https://onco.cc/key-papers/paper-st-gallen-2025-consensus-ann-oncol-2025/), [The clonal and mutational evolution spectrum of primary triple-negative breast cancers](https://onco.cc/key-papers/paper-shah-tnbc-clonal-evolution-nature-2012/), [The functional loss of the retinoblastoma tumour suppressor is a common event in basal-like and luminal B breast carcinomas](https://onco.cc/key-papers/paper-herschkowitz-rb1-loss-basal-like-bcr-2008/), [The impact of expanded access to germline high penetrance genetic testing for women with a new diagnosis of invasive breast cancer or high-grade DCIS](https://onco.cc/key-papers/paper-hudson-phillips-expanded-germline-testing-clin-breast-cancer-2026/), [The prevalence of BRCA1 and BRCA2 mutations among young Mexican women with triple-negative breast cancer](https://onco.cc/key-papers/paper-villarreal-garza-mexican-tnbc-brca-bcrt-2015/), [The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews](https://onco.cc/key-papers/paper-struewing-brca-founder-mutations-ashkenazi-nejm-1997/), [Triple-negative breast cancer risk genes identified by multigene hereditary cancer panel testing](https://onco.cc/key-papers/paper-shimelis-tnbc-risk-genes-jnci-2018/), [Triple-negative breast cancer: clinical features and patterns of recurrence](https://onco.cc/key-papers/paper-dent-tnbc-clinical-features-recurrence-ccr-2007/), [Tumor mutational burden and PTEN alterations as molecular correlates of response to PD-1/L1 blockade in metastatic triple-negative breast cancer](https://onco.cc/key-papers/paper-barroso-sousa-tmb-pten-ici-mtnbc-ccr-2020/), [Tumor-infiltrating lymphocytes and prognosis: a pooled individual patient analysis of early-stage triple-negative breast cancers](https://onco.cc/key-papers/paper-loi-tils-pooled-early-tnbc-jco-2019/), [Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer](https://onco.cc/key-papers/paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024/), [Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy](https://onco.cc/key-papers/paper-denkert-tils-neoadjuvant-pooled-lancet-oncol-2018/), [Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023](https://onco.cc/key-papers/paper-st-gallen-2023-consensus-ann-oncol-2023/), [Unraveling triple-negative breast cancer tumor microenvironment heterogeneity: towards an optimized treatment approach](https://onco.cc/key-papers/paper-bareche-tnbc-microenvironment-jnci-2020/), [Unravelling triple-negative breast cancer molecular heterogeneity using an integrative multiomic analysis](https://onco.cc/key-papers/paper-bareche-tnbc-multiomic-heterogeneity-ann-oncol-2018/), [Update on triple-negative breast cancer disparities for the United States: A population-based study from the United States Cancer Statistics database, 2010 through 2014](https://onco.cc/key-papers/paper-scott-tnbc-disparities-uscs-cancer-2019/), [Updated treatment recommendations for systemic treatment: from the ESMO Metastatic Breast Cancer Living Guideline](https://onco.cc/key-papers/paper-esmo-mbc-living-guideline-update-ann-oncol-2025/), [US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status](https://onco.cc/key-papers/paper-howlader-us-incidence-breast-subtypes-jnci-2014/), [Use of alternative medicine for cancer and its impact on survival](https://onco.cc/key-papers/paper-johnson-alternative-medicine-jnci-2018/), [Use of Immune Checkpoint Inhibitor Pembrolizumab in the Treatment of High-Risk, Early-Stage Triple-Negative Breast Cancer: ASCO Guideline Rapid Recommendation Update](https://onco.cc/key-papers/paper-asco-pembrolizumab-early-tnbc-rapid-update-jco-2022/), [Whole-genome sequencing of triple-negative breast cancers in a population-based clinical study](https://onco.cc/key-papers/paper-staaf-tnbc-whole-genome-scan-b-nat-med-2019/)
- journals: [Breast cancer](https://onco.cc/journals/breast-cancer-jbcs/), [Breast cancer research](https://onco.cc/journals/breast-cancer-research/), [Breast cancer research and treatment](https://onco.cc/journals/breast-cancer-research-and-treatment/), [Clinical breast cancer](https://onco.cc/journals/clinical-breast-cancer/), [Journal of breast imaging](https://onco.cc/journals/journal-of-breast-imaging/), [Journal of mammary gland biology and neoplasia](https://onco.cc/journals/journal-of-mammary-gland-biology-and-neoplasia/), [The Breast](https://onco.cc/journals/the-breast/), [The breast journal](https://onco.cc/journals/the-breast-journal/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)

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