# Triple-Negative This is the main hub for **triple-negative breast cancer**, or **TNBC**, on the site. TNBC is **ER-negative**, **PR-negative**, and **HER2-negative** on standard testing. ### In this section Jump to: * [Why TNBC needs its own treatment logic](#why-tnbc-needs-its-own-treatment-logic) * [Biomarkers that can change treatment decisions](#biomarkers-that-can-change-treatment-decisions) * [Standard treatment pathway](#standard-treatment-pathway) * [Support and practical resources](#support-and-practical-resources) * [Also relevant beyond this sub-type section](#also-relevant-beyond-this-sub-type-section) * [Selected references](#selected-references) * [Drug and brand names often used with TNBC](#drug-and-brand-names-often-used-with-tnbc) * [Treatment Resistance Research](/myhealingcommunity-docs/breast-cancer/triple-negative/treatment-resistance-research.md)
#### **Our TNBC *****treatment resistance research section***** includes pages on:**
* [Natural compounds](/myhealingcommunity-docs/breast-cancer/triple-negative/treatment-resistance-research/tnbc-natural-compounds-in-treatment-resistance-research.md) — microRNA, EMT, blueberry, pterostilbene, and piperlongumine research
* [Off-label drugs](/myhealingcommunity-docs/breast-cancer/triple-negative/treatment-resistance-research/tnbc-off-label-drugs-in-treatment-resistance-research.md) — pitavastatin, melatonin, metformin, aspirin, and related repurposing leads and
* [Emerging SOC strategies](/myhealingcommunity-docs/breast-cancer/triple-negative/treatment-resistance-research/emerging-resistance-strategies.md) — RNA-targeting and multi-target combinations that may shape the next wave of TNBC resistance work ### Why TNBC needs its own treatment logic TNBC is not one single disease. It is a mixed group of tumours with different molecular patterns, immune activity, and treatment sensitivities. Several features come up more often here: * **DNA-repair weakness.** **BRCA1/2** variants and wider **HRD** can make platinum drugs and **PARP inhibitors** more relevant. * **Immune variability.** Some tumours are more immune-active, with higher **TILs** or **PD-L1** expression. * **Earlier recurrence risk.** Relapse risk is often more front-loaded in the first few years after diagnosis. * **Strong neoadjuvant relevance.** Response before surgery matters a lot, and **pathologic complete response** usually signals a better outlook. ### Biomarkers that can change treatment decisions #### BRCA1, BRCA2, and HRD **BRCA1/2** testing matters in TNBC. It can affect treatment choice, inherited-risk assessment, and family counselling. Positive findings may support: * stronger interest in **platinum chemotherapy** * eligibility for **PARP inhibitors** * wider family risk assessment Broader **HRD** or **BRCAness** may also matter, even without a classic **BRCA** variant. #### PD-L1 **PD-L1** testing helps identify metastatic TNBC patients who may benefit from **pembrolizumab plus chemotherapy**. Assays and cut-offs vary. That makes report interpretation important. #### TILs and immune context Higher **tumour-infiltrating lymphocytes**, or **TILs**, often track with better chemotherapy response. They can also suggest a more active anti-tumour immune environment. TILs are not a stand-alone treatment selector, but they can still help frame prognosis. #### TROP2 and other emerging targets **TROP2** matters because it is the target of **sacituzumab govitecan**. Some TNBC tumours also sit in more specialised subgroups, including: * **HER2-low** or **HER2-mutant** disease * **androgen-receptor-positive** or **luminal androgen receptor** patterns * **PI3K/AKT/mTOR**-altered tumours These findings matter most in later-line planning or clinical-trial matching. ### Standard treatment pathway Treatment varies by stage, country, and prior therapy. #### Early-stage TNBC Treatment often starts with **neoadjuvant chemotherapy** before surgery in stage II to III disease. Common regimens combine an anthracycline, cyclophosphamide, a taxane, and sometimes carboplatin. **Pembrolizumab** now matters in selected high-risk early-stage settings. After systemic therapy, treatment usually moves to surgery and then radiation when indicated. Residual disease can change the next step. That may include **capecitabine**, ongoing **pembrolizumab**, or **olaparib** in selected **gBRCA1/2** cases. #### Metastatic or advanced TNBC Chemotherapy still anchors treatment in metastatic disease. **Pembrolizumab plus chemotherapy** matters in **PD-L1-positive** metastatic TNBC. **PARP inhibitors** matter in selected **gBRCA1/2-mutated**, **HER2-negative** disease. **Sacituzumab govitecan** matters after prior chemotherapy exposure. Later-line options can also include **capecitabine**, **eribulin**, **vinorelbine**, or **gemcitabine**. Palliative radiation, bone support, symptom control, and multidisciplinary care stay central throughout. ### Also relevant beyond this sub-type section These pages live outside this subsection, but they often help frame TNBC questions. [Breast Cancer Pathways Project](/myhealingcommunity-docs/breast-cancer/support-groups/breast-cancer-pathways-project.md)\ Free worksheet downloads and pathways-based planning support. [Breast Cancers Overview](/myhealingcommunity-docs/breast-cancer/breast-cancers-overview.md)\ Main breast-cancer hub for subtype navigation and cross-subtype pages. [Treatment Resistance Overview](/myhealingcommunity-docs/treatment-resistance/treatment-resistance-overview.md)\ Wider framework for resistance patterns and escape logic across cancers. ### Selected references * [Triple-negative breast cancer review](https://pmc.ncbi.nlm.nih.gov/articles/PMC4181680/) * [BRCA, HRD, and precision treatment in TNBC](https://pmc.ncbi.nlm.nih.gov/articles/PMC10252475/) * [Immunotherapy and PD-L1 context in TNBC](https://pmc.ncbi.nlm.nih.gov/articles/PMC8556097/) * [TNBC heterogeneity and metabolic reprogramming](https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00428/full) * [Immune microenvironment and TIL context in TNBC](https://www.nature.com/articles/s41523-025-00814-y) ### Drug and brand names often used with TNBC
Expand the TNBC treatment-name glossary On this site, drug names usually appear as the **generic name first**, then the **brand name in brackets**. Brand names can vary by country. **Common chemotherapy backbones** * **Doxorubicin** — **Adriamycin** and **epirubicin** — **Ellence**. Anthracyclines often pair with **cyclophosphamide** in early-stage TNBC. * **Paclitaxel** — **Taxol** and **docetaxel** — **Taxotere**. Taxanes are used in neoadjuvant, adjuvant, and metastatic settings. * **Carboplatin** — **Paraplatin** and **cisplatin** — **Platinol**. Platinum drugs matter most when **BRCA1/2** or wider **HRD** is in the picture. **Immunotherapy** * **Pembrolizumab** — **Keytruda**. A **PD-1 inhibitor** used with chemotherapy in selected high-risk early-stage and **PD-L1-positive** metastatic TNBC. **PARP inhibitors** * **Olaparib** — **Lynparza**. Used in selected **gBRCA1/2-mutated**, **HER2-negative** breast cancer settings. * **Talazoparib** — **Talzenna**. Another **PARP inhibitor** used in metastatic **HER2-negative** disease with germline **BRCA** variants. **Antibody-drug conjugates** * **Sacituzumab govitecan** — **Trodelvy**. A **TROP2-directed ADC** used in previously treated metastatic TNBC.

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