Aside from germline BRCA1/2 deficiency, which now has an approved targeted therapy, PARP inhibition, and programmed cell death ligand 1 (PD-L1)-positive tumors, for which immunotherapy with a PD-L1 inhibitor is now approved, attempts to identify biomarkers that can help guide treatment decisions with targeted therapies have yet to improve the outcomes of patients with metastatic TNBC, and cytotoxic chemotherapy remains the mainstay of treatment. 1 TNBC is often the most challenging subtype of breast cancer to treat for various clinical and biological reasons. Clinically, TNBC is often an aggressive tumor subtype associated with an earlier age of onset, higher rate of relapse, and a relatively short survival of 10–13 months from the time of metastasis. Triple negative breast cancer (TNBC) is a heterogeneous tumor subtype conventionally defined by the absence of expression of the estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 ( HER2) amplification, and accounts for approximately 15–20% of all breast carcinomas.
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