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Triple-negative breast cancer is a heterogeneous disease and specific therapies have not been available for a long time. Therefore, conventional chemotherapy is still considered the clinical state of the art. Different subgroups of triple-negative breast cancer have been identified on the basis of protein expression, mRNA signatures, and genomic alterations. Important elements of triple-negative breast cancer biology include high proliferative activity, an increased immunological infiltrate, a basal-like and a mesenchymal phenotype, and deficiency in homologous recombination, which is in part associated with loss of BRCA1 or BRCA2 function. A minority of triple-negative tumours express luminal markers, such as androgen receptors, and have a lower proliferative activity. These biological subgroups are overlapping and currently cannot be combined into a unified model of triple-negative breast cancer biology. Nevertheless, the molecular analysis of this disease has identified potential options for targeted therapeutic intervention. This has led to promising clinical strategies, including modified chemotherapy approaches targeting the DNA damage response, angiogenesis inhibitors, immune checkpoint inhibitors, or even anti-androgens, all of which are being evaluated in phase 1-3 clinical studies. This Series paper focuses on the most relevant clinical questions, summarises the results of recent clinical trials, and gives an overview of ongoing studies and trial concepts that will lead to a more refined therapy for this tumour type., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose of Review: Although patients with hormone receptor-positive and/or HER2-positive breast cancer benefit from endocrine and HER2-targeted agents in addition to combination chemotherapy regimens, patients with triple-negative breast cancer (TNBC) suffer from a particularly unfavorable prognosis particularly when not responding well to anthracycline-taxane chemotherapy. Novel treatment options are urgently needed to improve prognosis of these patients as well., Recent Findings: Potential options for optimized therapy of patients with TNBC consist in, first, optimization of chemotherapy through optimization of chemotherapy regimens with may be reached through optimized (i.e., dose-dense) scheduling, second, optimization of chemotherapy through introduction of novel chemotherapy agents (such as platinum compounds as alternative of additional chemotherapy), third, identification and development of novel targeted agents, and fourth, identification of patients with or without response through biomarkers to individual treatments to allow for a more personalized treatment approach., Summary: We summarize recent findings for novel treatment options particularly focusing on platinum-based chemotherapy, potential novel targeted therapies such as antiangiogenic agents or inhibition of poly-A-ribose-polymerase, and prognostic/predictive biomarkers such as tumor-infiltrating lymphocytes or BRCA.

Within the last decade, breast cancer is increasingly understood as a heterogeneous disease comprising distinct entities that vary significantly with regard to molecular biology and clinical features. Despite impressive advances in the treatment of patients with breast cancer, not all patients derive equal benefits from current therapeutic options and a significant number of patients still experience disease recurrence. Whereas for patients with hormone receptor positive and/or HER2/neu-positive breast cancer overcoming resistance against endocrine and/or anti-HER2/neu-targeted therapy is of particular importance, patients with triple negative breast cancer suffer from a lack of sufficient targeted therapeutic options at all. In this review we give a summary of the most important targeted agents recently or currently being developed for patients with breast cancer., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Purpose: CDK4/6 inhibitors (CDK4/6i) combined with endocrine therapy are considered standard-of-care for first-line therapy of patients with hormone receptor positive, HER2 negative, advanced breast cancer (HR+/HER2- ABC). Superiority of combination therapy over endocrine monotherapy has been demonstrated in a multitude of randomized controlled trials (RCTs) in phase III and IV. However, RCTs reflect clinical reality only to a limited extent, as narrow inclusion criteria lead to a selected patient collective. Here, we present real-world data (RWD) on CDK4/6i treatment in patients with HR+/HER2- ABC at four certified German university breast cancer centers. Methods: Patients diagnosed with HR+/HER2- ABC who were treated in clinical routine with CDK4/6i between November 2016 and December 2020 at four certified German university breast cancer centers (Saarland University Medical Center, University Medical Center Charité Berlin, University Medical Center Bonn, and University Medical Center Hospital Schleswig-Holstein, Campus Kiel) were identified and enrolled in this retrospective study. Clinicopathological characteristics and clinical outcomes were recorded with particular emphasis on CDK4/6i therapy course [progression-free survival (PFS) following treatment initiation, toxicity, dose reduction, therapy discontinuation, prior and subsequent therapy line]. Results: Data from n = 448 patients were evaluated. The mean patient age was 63 (±12) years. Of these patients, n = 165 (36.8%) were primarily metastasized, and n = 283 (63.2%) had secondary metastatic disease. N = 319 patients (71.3%) received palbociclib, n = 114 patients (25.4%) received ribociclib, and n = 15 patients (3.3%) received abemaciclib, respectively. Dose reduction was performed in n = 132 cases (29.5%). N = 57 patients (12.7%) discontinued the treatment with CDK4/6i due to side effects. N = 196 patients (43.8%) experienced disease progression under CDK4/6i treatment. The median PFS was 17 months. Presence of hepatic metastases and prior therapy lines were associated with shorter PFS, whereas estrogen positivity and dose reduction due to toxicity were positively associated with PFS. Presence of bone and lung metastases, progesterone positivity, Ki67 index, grading, BRCA1/2 and PIK3CA mutation status, adjuvant endocrine resistance, and age did not significantly impact on PFS. Conclusion: Our RWD analysis on CDK4/6i treatment in Germany supports data from RCTs regarding both treatment efficacy and safety of CDK4/6i for treatment of patients with HR+/HER2- ABC. In comparison to data from the pivotal RCTs, median PFS was lower but within the expected range for RWD, which could result from inclusion of patients with more advanced diseases (i.e., higher therapy lines) to our dataset. [ABSTRACT FROM AUTHOR]

The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2022 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer. [ABSTRACT FROM AUTHOR]

An interview with 2021 San Antonio Breast Cancer Symposium (SABS) officials like Rubert Bartsch, Cornelia Kolberg-Liedtke, and Carlo Palmieri is presented. They talk about the highlights of the symposium on topics like the neoadjuvant atezolizumab therapy, imaging mass cytometry (IMC), and the location of cells within the tumor microenvironment (TME). They cite the role of anthracyclines as component of adjuvant chemotherapy.

The article offers information on recommendations in the diagnosisand treatment of advanced breast cancer. It discusses various procedures and complications of local treatment and menopausal symptoms. The article offers information on Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) guidelines on trastuzumab therapy, managing bone health, and importance of follow-up for invasive cancer.

Background: Pathological complete response (pCR) is associated with improved prognosis in triple-negative breast cancer (TNBC). The optimal chemotherapy regimen is unclear. Weekly nab-paclitaxel vs conventional paclitaxel or addition of carboplatin to anthracycline-taxane results in higher pCR rates with uncertain survival impact. We evaluated carboplatin vs gemcitabine with a nab-paclitaxel backbone as a short 12-week A-free regimen with a focus on early response.Methods: Patients with TNBC (estrogen receptor/progesterone receptor < 1%, human epidermal growth factor receptor 2-negative, cT1c-cT4c, cN0/+) were randomly assigned to A: nab-paclitaxel 125 mg/m2/gemcitabine 1000 mg/m2 d1,8 three times weekly (q3w); vs B: nab-paclitaxel 125 mg/m2/carboplatin AUC2 day 1,8 q3w. The trial was powered for a pCR (ypT0/is ypN0) comparison by therapy arm and early response (defined as Ki-67 decrease >30% or < 500 invasive tumor cells in the three-week serial biopsy). All statistical tests were two-sided.Results: A total of 336 patients were enrolled (48 centers, arms A/B: n = 182/154). The median age was 50 years. At baseline (A vs B), 62.6% and 62.9% had cT2-4c tumors; 86.8% and 90.9% completed therapy per protocol, respectively. pCR favored arm B (28.7%, 95% CI = 0.22 to 0.36, vs 45.9%, 95% CI = 0.38 to 0.54; 95% CI(dBA) = 6.2% to 27.9%, P = .002) and was lower in nonresponders than in early responders (19.5% vs 44.4%, P < .001) or in patients with unclassifiable early response (50.0%). The nab-paclitaxel/gemcitabine was associated with more frequent dose reductions (20.6% vs 11.9%, P = .04), treatment-related serious adverse events (11.1% vs 5.3%, P = .07), grade 3-4 infections (7.2% vs 2.6%, P = .07), and grade 3-4 ALAT elevations (11.7 vs 3.3%, P = .01).Conclusions: This first large randomized trial suggests high efficacy and excellent tolerability of a neoadjuvant nab-paclitaxel/carboplatin regimen, superior to nab-paclitaxel/gemcitabine in TNBC. De-escalation of further chemotherapy in patients with early pCR after a short anthracycline-free regimen is a promising field of future research. Early necrotic morphological changes and/or proliferation decrease after the first therapy cycle seem to be associated with subsequent pCR. [ABSTRACT FROM AUTHOR]

Systemic therapy of metastatic breast cancer may include chemotherapy, endocrine therapy, and targeted therapies (e.g., antibody-based approaches). These agents may be employed alone or in combination based on the patient's breast cancer subtype. Therefore, characterization of the disease phenotype is necessary and may include biopsy of the metastatic site. Novel therapeutic approaches include immunologic therapies, PARP inhibitors, PI3K inhibitors, and CDK4/6 inhibitors, which are currently under investigation in clinical trials. [ABSTRACT FROM AUTHOR]

The article discusses the 2016 update from the Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) on the recommendations for the treatment and diagnosis of patients who suffered from metastatic and advanced breast cancer.

The key topics of this year's 14th St. Gallen Consensus Conference on the diagnosis and therapy of primary breast cancer were again questions about breast surgery and axillary surgery, radio-oncology and systemic therapy options in consideration of tumor biology, and the clinical application of multigene assays. This year, the consensus conference took place in Vienna. From a German perspective, it makes sense to substantiate the results of the vote of the international panel representing 19 countries in light of the updated national therapy recommendations of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie). Therefore, 14 German breast cancer experts, 3 of whom are members of the International St. Gallen Panel, have commented on the voting results of the St. Gallen Consensus Conference 2015 in relation to clinical routine in Germany. [ABSTRACT FROM AUTHOR]

The article focuses on the recommendations from the German Gynecological Oncology Group (AGO), regarding the early diagnosis and advanced treatment for metastatic breast cancer. Information regarding the treatment of bone metastases, major goals of breast cancer follow-up studies, and effectiveness of endocrine and targeted therapy for metastatic breast cancer, are discussed.

Information on several topics discussed at the San Antonio Breast Cancer Symposium 2014 is presented. Topics include drug development for breast cancer, the platinum efficacy in patients with triple negative breast cancer (TNBC), and contralateral prophylactic mastectomy. The event featured various participants including Rachel Wuerstlein, Alessandra Gennari, and Cornelia Liedtke.

No abstract available [ABSTRACT FROM AUTHOR]

No abstract available [ABSTRACT FROM AUTHOR]

Patients with triple-negative breast cancer are characterized by a poor prognosis compared with patients with other breast cancer subtypes. The angiogenesis inhibitor bevacizumab is effective in the palliative treatment of patients with triple-negative breast cancer as well as in other breast cancer subtypes. PARP inhibitors represent the first group of targeted agents to be developed under the particular aspect of treating patients with hereditary and triple-negative breast cancer. In addition, an increasing number of studies have demonstrated a significant and clinically relevant change in phenotype between primary tumor and metastasis. Consequently, it should be an essential component of the design of modern clinical trials of targeted agents in metastatic breast cancer to determine the relevant tumor phenotype and, depending on the clinical situation, confirm the presence of the therapeutic target in metastatic lesions. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article presents questions and answers related to the new findings concerning chemotherapy, bisphosphonates, and endocrine therapy that may affect clinical decisions in the treatment of breast cancer.