Bridging the Gap: Value-Based Systemic Therapy for Triple-Negative Breast Cancer
Authors: Dr. Anjali Shah
Institution: ACTREC, Tata Memorial Centre
Introduction
Triple-negative breast cancer (TNBC) makes up a disproportionately high share of breast cancer in South Asia. It presents at a younger age and carries the highest early risk of recurrence among breast cancer subtypes. Therapeutic advances over the past decade have improved outcomes in both early and metastatic disease. Their uptake in low- and middle-income countries, however, remains limited, widening the gap between efficacy and effectiveness.
Methods
In early TNBC, pathological complete response (pCR) after neoadjuvant therapy is a strong surrogate for event-free and overall survival. Adding platinum and immune checkpoint inhibitors to neoadjuvant chemotherapy has raised pCR rates. In residual disease, adjuvant capecitabine and, for germline BRCA mutation carriers, olaparib improve survival. This makes upfront germline testing essential.
Results
In metastatic TNBC, treatment is now selected by biomarkers. Options include immunotherapy for programmed death-ligand 1 (PD-L1)-positive disease, antibody–drug conjugates and poly(ADP-ribose) polymerase (PARP) inhibitors. Emerging data on sequencing and on combinations in earlier lines are reshaping this landscape. Key controversies remain: • the optimal platinum schedule; • whether adjuvant immunotherapy is needed after pCR; • de-escalation in low-risk disease; • How to interpret pCR gains before survival data mature.
Conclusion
Finally, this lecture outlines strategies to bridge the gap between evidence and access. These include affordable alternative agents, low-dose immunotherapy, wider germline testing and the generation of evidence relevant to our populations.