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Abstract：
BACKGROUND: Triple-negative breast cancer (TNBC) remains a clinically challenging subtype due to its aggressive nature and limited treatment options post-neoadjuvant failure. Historically, capecitabine has been the cornerstone of adjuvant therapy for TNBC patients not achieving a pathological complete response (pCR). However, the integration of new modalities such as immunotherapy and PARP inhibitors has prompted a re-evaluation of traditional post-neoadjuvant approaches.
METHODS: This review synthesizes data from pivotal clinical trials and meta-analyses to evaluate the efficacy of emerging therapies in the post-neoadjuvant setting. We focus on the role of immune checkpoint inhibitors (ICIs), PARP inhibitors (PARPis), and antibody-drug conjugates (ADCs) alongside or in place of capecitabine in TNBC treatment paradigms.
RESULTS: The addition of ICIs like pembrolizumab to neoadjuvant regimens has shown increased pCR rates and improved event-free survival, posing new questions about optimal post-neoadjuvant therapies. Similarly, PARPis have demonstrated efficacy in BRCA-mutated TNBC populations, with significant improvements in disease-free survival (DFS) and overall survival (OS). Emerging studies on ADCs further complicate the adjuvant landscape, offering potentially efficacious alternatives to capecitabine, especially in patients with residual disease after neoadjuvant therapy.
CONCLUSIONS: The challenge remains to integrate these new treatments into clinical practice effectively, considering factors such as drug resistance, patient-specific characteristics, and socio-economic barriers. This review discusses the implications of these therapies and suggests a future direction focused on personalized medicine approaches in TNBC.
CONCLUSIONS: As the treatment landscape for TNBC evolves, the role of capecitabine is being critically examined. While it remains a viable option for certain patient groups, the introduction of ICIs, PARPis, and ADCs offers promising alternatives that could redefine adjuvant therapy standards. Ongoing and future trials will be pivotal in determining the optimal therapeutic strategies for TNBC patients with residual disease post-neoadjuvant therapy.
METHODS: This review synthesizes data from pivotal clinical trials and meta-analyses to evaluate the efficacy of emerging therapies in the post-neoadjuvant setting. We focus on the role of immune checkpoint inhibitors (ICIs), PARP inhibitors (PARPis), and antibody-drug conjugates (ADCs) alongside or in place of capecitabine in TNBC treatment paradigms.
RESULTS: The addition of ICIs like pembrolizumab to neoadjuvant regimens has shown increased pCR rates and improved event-free survival, posing new questions about optimal post-neoadjuvant therapies. Similarly, PARPis have demonstrated efficacy in BRCA-mutated TNBC populations, with significant improvements in disease-free survival (DFS) and overall survival (OS). Emerging studies on ADCs further complicate the adjuvant landscape, offering potentially efficacious alternatives to capecitabine, especially in patients with residual disease after neoadjuvant therapy.
CONCLUSIONS: The challenge remains to integrate these new treatments into clinical practice effectively, considering factors such as drug resistance, patient-specific characteristics, and socio-economic barriers. This review discusses the implications of these therapies and suggests a future direction focused on personalized medicine approaches in TNBC.
CONCLUSIONS: As the treatment landscape for TNBC evolves, the role of capecitabine is being critically examined. While it remains a viable option for certain patient groups, the introduction of ICIs, PARPis, and ADCs offers promising alternatives that could redefine adjuvant therapy standards. Ongoing and future trials will be pivotal in determining the optimal therapeutic strategies for TNBC patients with residual disease post-neoadjuvant therapy.
摘要：
背景：三阴性乳腺癌（TNBC）由于其侵袭性和新辅助失败后有限的治疗选择，仍然是一种具有临床挑战性的亚型。历史上,卡培他滨一直是未达到病理完全缓解(pCR)的TNBC患者的辅助治疗的基石。然而,免疫治疗和PARP抑制剂等新方法的整合促使人们对传统的新辅助治疗后方法进行了重新评估.
方法：这篇综述综合了来自关键临床试验和荟萃分析的数据，以评估新辅助治疗后的疗效。我们专注于免疫检查点抑制剂（ICIs）的作用，PARP抑制剂（PARPis），在TNBC治疗范例中，抗体-药物缀合物（ADC）与卡培他滨一起或代替卡培他滨。
结果：在新辅助治疗方案中加入pembrolizumab等ICIs已显示出pCR率增加和无事件生存率改善，提出了关于新辅助治疗后最佳治疗的新问题。同样，PARPis已证明在BRCA突变的TNBC群体中有效，无病生存期（DFS）和总生存期（OS）显着改善。对ADC的新兴研究进一步使佐剂景观复杂化，提供卡培他滨的潜在有效替代品，特别是在新辅助治疗后残留疾病的患者中。
结论：将这些新的治疗方法有效地融入临床实践仍然是一个挑战。考虑到耐药性等因素，患者特有的特征，和社会经济障碍。这篇综述讨论了这些疗法的含义，并提出了TNBC个性化医疗方法的未来方向。
结论：随着TNBC治疗前景的发展，卡培他滨的作用正在严格检查中。虽然它仍然是某些患者群体的可行选择，ICIs的推出，PARPis,ADC提供了有希望的替代方案，可以重新定义辅助治疗标准。正在进行和未来的试验对于确定新辅助治疗后残留疾病的TNBC患者的最佳治疗策略至关重要。
方法：这篇综述综合了来自关键临床试验和荟萃分析的数据，以评估新辅助治疗后的疗效。我们专注于免疫检查点抑制剂（ICIs）的作用，PARP抑制剂（PARPis），在TNBC治疗范例中，抗体-药物缀合物（ADC）与卡培他滨一起或代替卡培他滨。
结果：在新辅助治疗方案中加入pembrolizumab等ICIs已显示出pCR率增加和无事件生存率改善，提出了关于新辅助治疗后最佳治疗的新问题。同样，PARPis已证明在BRCA突变的TNBC群体中有效，无病生存期（DFS）和总生存期（OS）显着改善。对ADC的新兴研究进一步使佐剂景观复杂化，提供卡培他滨的潜在有效替代品，特别是在新辅助治疗后残留疾病的患者中。
结论：将这些新的治疗方法有效地融入临床实践仍然是一个挑战。考虑到耐药性等因素，患者特有的特征，和社会经济障碍。这篇综述讨论了这些疗法的含义，并提出了TNBC个性化医疗方法的未来方向。
结论：随着TNBC治疗前景的发展，卡培他滨的作用正在严格检查中。虽然它仍然是某些患者群体的可行选择，ICIs的推出，PARPis,ADC提供了有希望的替代方案，可以重新定义辅助治疗标准。正在进行和未来的试验对于确定新辅助治疗后残留疾病的TNBC患者的最佳治疗策略至关重要。
