The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs.

During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC.

The consensus was subsequently updated based on the most recent data evolved lately.

A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilised.

The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer.

The final consensus was later circulated to the panellists for critical revision of important intellectual content.

These recommendations represent the available clinical evidence and expert opinion when evidence is scarce.

The percentage of the consensus votes, levels of evidence and grades of recommendation were presented in the guidelines for each statement.

The consensus covered all the aspects of TNBC management, starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. In 70% of the statements (35/50), the consensus was reached.

The main topics covered were the definition of TNBC and pathology evaluation, loco-regional treatment for TNBC, neoadjuvant therapy (NAT) for TNBC, adjuvant therapy for TNBC and the metastatic setting for TNBC.

These guidelines discussed the role of NAT in early TNBC with the incorporation of platinum suggested in some settings; the loco-regional management, including the use of hypo-fractionated regimens; tailoring adjuvant therapy according to the residual disease after NAT; and the role of platinum-based chemotherapy and immunotherapy in the management of advanced TNBC.

In addition, many areas for future research were identified, including the role of androgen-receptor-targeted therapy, the predictive value of tumour-infiltrating lymphocytes and Ki-67 and their role in tailoring treatment, the role of platinum-based chemotherapy in the neoadjuvant setting and the role of anti-PD-L1 treatment in the management of early and advanced TNBC.

Complete guidelines can be read here.

Source: BGICC