Metastatic triple-negative breast cancer: lines of therapy

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5 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	BRCA / HRD	PD-L1
Advanced, first line	1	·	1
Third line and beyond	1	·	·
Special situations	1	·	·
Other settings	·	1	·

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	First line, combined positive score 10 or more	Pembrolizumab with chemotherapy (KEYNOTE-355) or with sacituzumab govitecan (ASCENT-04).	PembrolizumabKEYNOTE-355Sacituzumab govitecanASCENT-04 / KEYNOTE-D19Combined positive score (CPS)		98
PD-L1	First line, PD-L1-negative or immunotherapy-ineligible	Datopotamab deruxtecan (TROPION-Breast02) or sacituzumab govitecan (ASCENT-03); a taxane or platinum where antibody-drug conjugates are unavailable.	Datopotamab deruxtecanTROPION-Breast02Sacituzumab govitecanASCENT-03Paclitaxel / nab-paclitaxelCarboplatin		91

Third line and beyond

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Second line and beyond	Whichever TROP2 antibody-drug conjugate has not been used (ASCENT); trastuzumab deruxtecan for HER2-low tumours (DESTINY-Breast04); izalontamab brengitecan where available; eribulin, capecitabine or gemcitabine with carboplatin.	Sacituzumab govitecanASCENTTrastuzumab deruxtecanDESTINY-Breast04Izalontamab brengitecanEribulinCapecitabineGemcitabine		97

Special situations

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Brain metastases	Stereotactic radiosurgery or whole-brain radiotherapy with continued systemic therapy; antibody-drug conjugates have early evidence of intracranial activity.	Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)Brain metastases (intracranial disease)		32

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
BRCA / HRD	Germline BRCA carriers	Olaparib (OlympiAD) or talazoparib (EMBRACA) after or instead of first-line chemotherapy; platinum chemotherapy is also more active.	OlaparibOlympiADTalazoparibEMBRACACarboplatinGermline BRCA mutation (gBRCA)		87

Sequence and caution pairings

CautionApproved

Caution: DXd ADC + agents with pneumonitis risk

Enhertu and its DXd cousins can inflame the lungs; combining them with immunotherapy, radiation, or mTOR inhibitors stacks that risk.

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.