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The treatment of triple-negative breast cancer that has spread has been transformed since 2020, though it is not yet curable. By PD-L1 score, first treatment is pembrolizumab with chemotherapy or with sacituzumab govitecan, or datopotamab deruxtecan or sacituzumab govitecan alone; BRCA carriers can take a PARP inhibitor tablet; and trastuzumab deruxtecan reaches the third of tumours with low HER2.
Metastatic triple-negative disease spreads early to lung, liver and brain and grows fast, so the first line matters more than in other breast cancers. At relapse the tumour is retested, because receptors can change, and three results steer treatment: PD-L1 by combined positive score (10 or more in roughly four in ten patients), germline BRCA status and the HER2 immunohistochemistry score that identifies HER2-low disease. Until 2018 the options were taxanes, anthracyclines, platinum, capecitabine and eribulin, with platinum favoured in BRCA carriers after the TNT trial.
Immunotherapy came first. IMpassion130 showed atezolizumab with nab-paclitaxel delays progression in PD-L1-positive disease and won an accelerated approval that was withdrawn in 2021 when IMpassion131 with paclitaxel failed. KEYNOTE-355 (847 patients) showed pembrolizumab with chemotherapy extends survival in tumours with a combined positive score of 10 or more (hazard ratio 0.73) and became the first-line standard for that group. The TROP2 antibody-drug conjugates then moved into the first line: ASCENT-04 showed sacituzumab govitecan with pembrolizumab beats chemotherapy with pembrolizumab in PD-L1-positive disease, ASCENT-03 showed sacituzumab govitecan beats chemotherapy in PD-L1-negative disease, and TROPION-Breast02 (644 patients) showed datopotamab deruxtecan extends overall survival from 18.7 to 23.7 months in patients who cannot have immunotherapy, the first first-line antibody-drug conjugate to do so; all three were approved in 2026.
Later lines were transformed earlier. ASCENT (529 patients with at least two prior lines) showed sacituzumab govitecan nearly doubles survival against chemotherapy (12.1 against 6.7 months, hazard ratio 0.48), the first antibody-drug conjugate approval in triple-negative disease in 2020. For germline BRCA carriers OlympiAD (302 patients) and EMBRACA (431) showed olaparib and talazoparib extend progression-free survival over chemotherapy (7.0 against 4.2 months, hazard ratio 0.58; 8.6 against 5.6 months, hazard ratio 0.54) without a significant survival gain. DESTINY-Breast04 included a small HER2-low triple-negative cohort that pointed the same way as the main result, and trastuzumab deruxtecan is an option for the third of tumours that are HER2-low; the bispecific antibody-drug conjugate izalontamab brengitecan posted a positive phase 3 in 2026. Whether a second topoisomerase-payload conjugate works after the first, how to select patients for TROP2 drugs, and what to do about brain metastases, present in up to a third to nearly half of patients, are the open questions.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Pembrolizumab with chemotherapy (KEYNOTE-355) or with sacituzumab govitecan (ASCENT-04).
Datopotamab deruxtecan (TROPION-Breast02) or sacituzumab govitecan (ASCENT-03); a taxane or platinum where antibody-drug conjugates are unavailable.
Olaparib (OlympiAD) or talazoparib (EMBRACA) after or instead of first-line chemotherapy; platinum chemotherapy is also more active.
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.
Stereotactic radiosurgery or whole-brain radiotherapy with continued systemic therapy; antibody-drug conjugates have early evidence of intracranial activity.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
A swollen painful calf, or sudden breathlessness with chest pain; venous thromboembolism including pulmonary embolism is a labelled warning.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Temperature of 38 C or higher. Sacituzumab govitecan carries a boxed warning for severe or life-threatening neutropenia.
See all on the product pages:CapecitabineCarboplatinDatopotamab deruxtecanEribulinGemcitabineIzalontamab brengitecanOlaparibPaclitaxel / nab-paclitaxelPembrolizumabSacituzumab govitecanTalazoparibTrastuzumab deruxtecan·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Metastatic triple-negative breast cancer, then print the one-page appointment sheet with room for the answers.
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.