TNBC treatment in the United States has evolved rapidly over the past decade, driven by advances in immunotherapy, targeted therapies, and antibody drug conjugates. Triple negative breast cancer, defined by the absence of estrogen and progesterone receptors and the lack of HER2 amplification, presents unique challenges because it does not respond to hormonal therapies that help other breast cancer subtypes. In the United States, treatment decisions hinge on disease stage, biomarker status, genetic architecture, prior therapies, and patient preferences. The landscape now blends standard care with precision medicine and access to cutting edge clinical trials, offering more options than ever before.
For most patients with early stage TNBC, the foundational approach remains surgery to remove the tumor, followed by chemotherapy and radiation therapy as indicated. Neoadjuvant chemotherapy, given before surgery, is commonly used to shrink tumors and can provide important prognostic information based on the pathological response. A complete or near complete response after neoadjuvant treatment correlates with improved long term outcomes. In many cases, standard chemotherapy regimens include a taxane and an anthracycline, sometimes supplemented with platinum agents, depending on the disease characteristics and institutional protocols. Adjuvant chemotherapy after surgery continues to be a consideration for patients with high risk features.
For metastatic or advanced disease, the treatment framework expands to systemic therapies designed to control disease, alleviate symptoms, and prolong survival. Immunotherapy has become a central pillar for many patients whose tumors express certain biomarkers. Pembrolizumab, when combined with a chemotherapy backbone, has demonstrated improved outcomes in several trials for PD L1 positive TNBC, and is routinely considered in suitable patients. The decision to use immunotherapy is guided by biomarker testing and patient tolerance, as immune related side effects require careful monitoring. PARP inhibitors, such as olaparib or talazoparib, offer a targeted option for patients with BRCA1 or BRCA2 gene mutations, reflecting the growing emphasis on germline testing as part of the TNBC workup. These agents can be used in specific lines of therapy and have become a standard consideration for BRCA mutated TNBC.
A notable addition in the TNBC treatment arsenal is the antibody-drug conjugate sacituzumab govitecan, marketed as Trodelvy. This therapy provides an option for metastatic TNBC that has progressed after prior treatments, delivering a targeted cytotoxic payload to cancer cells while sparing some normal tissue. The availability of Trodelvy has altered the prognosis for many patients with advanced TNBC and has increased the importance of biomarker-informed decision making. While these therapies represent the core of current practice, several other agents and combinations are under investigation in clinical trials, underscoring the value of trial participation for many patients.
