MD-OncoMD-OncoMD-Onco2782-32022782-6171Publishing House ABV Press21610.17650/2782-3202-2026-6-1-14-23NEW APPROACHES AND SUCCESSES IN TREATMENT OF ONCOLOGICAL PATIENTS AT THE CURRENT STAGEНОВЫЕ НАПРАВЛЕНИЯ И УСПЕХИ В ЛЕЧЕНИИ ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ НА СОВРЕМЕННОМ ЭТАПЕReview ArticleModern possibilities of drug therapy for early and locally advanced triple negative breast cancerСовременные возможности лекарственной терапии раннего и местно-распространенного тройного негативного рака молочной железыhttps://orcid.org/0000-0002-4709-1726BelokhvostovaA. S.БелохвостоваА. С.
Russian Federation
galitsyna.anastaisha@gmail.comhttps://orcid.org/0009-0009-0188-8420GalitsynaA. B.ГалицынаАнастасия Борисовна
Russian Federation
galitsyna.anastaisha@gmail.comhttps://orcid.org/0009-0008-0769-1736SofiychukA. A.СофийчукА. А.
Russian Federation
galitsyna.anastaisha@gmail.comhttps://orcid.org/0000-0002-0023-4216FalaleevaN. A.ФалалееваН. А.
Russian Federation
galitsyna.anastaisha@gmail.comhttps://orcid.org/0009-0002-6631-3862AbdulkhalimA. I.A.АбдулхалимА. И.А.
Russian Federation
galitsyna.anastaisha@gmail.comA.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of RussiaМедицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииObninsk Institute for Nuclear Power Engineering – branch of the National Research Nuclear University MEPHIОбнинский институт атомной энергетики – филиал ФГАОУ ВО «Национальный исследовательский ядерный университет «МИФИ»RUDN UniversityФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»0804202661MD-Onco142302022026Copyright ©; 2026, ABV-PressCopyright ©; 2026, АБВ-пресс2026ABV-PressАБВ-прессhttps://mdonco.abvpress.ru/jour/about/editorialPolicieshttps://mdonco.abvpress.ru/jour/article/view/216

Triple negative breast cancer remains the subtype of breast cancer with the highest rates of recurrence and mortality. Research in the field of tumor biology has led to identification of subgroups of patients with specific molecular features, which has led to the development and approval of many new targeted treatments for this disease.

This review considers current options for the treatment of locally advanced forms of breast cancer at the neoadjuvant stage – the use of carboplatin, targeted therapy with vascular endothelial growth factor inhibitors and immunotherapy. It discusses the practical problems and unanswered questions that arise in connection with the approval of neoadjuvant immunotherapy, and describes the approach used in the clinical practice to use various treatment options and the possibility of combining them to achieve the best early and long-term results.

Тройной негативный рак молочной железы остается подтипом рака молочной железы с самыми высокими показателями рецидивов и смертности. Результаты исследований в области биологии опухоли позволили выявить подгруппы пациентов со специфическими молекулярными особенностями, что привело к разработке и одобрению множества новых таргетных методов лечения данного заболевания.

Настоящий обзор посвящен современным опциям терапии местно-распространенных форм тройного негативного рака молочной железы на неоадъювантном этапе: применению препаратов карбоплатина, таргетной терапии ингибиторами фактора роста эндотелия сосудов и иммунотерапии. Обсуждаются практические проблемы и вопросы, оставшиеся без ответов, в связи с одобрением неоадъювантной иммунотерапии. Рассмотрен применяемый в клинической практике подход с использованием различных вариантов лечения и возможности их комбинации для достижения наилучших ранних и отдаленных результатов.

breast cancertriple negative breast cancertargeted therapyimmunotherapyрак молочной железытройной негативный рак молочной железытаргетная терапияиммунотерапияGlobocan 2020: Cancer today. International Agency for Research on Cancer (IARC), 2020. Available at: https://gco.iarc.fr/todayState of oncological care in Russia in 2022. Eds.: А.D. Kaprin, V.V. Starinskiy, A.O. Shachzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2023. 239 p. (In Russ.).Состояние онкологической помощи населению России в 2022 году. Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2023. 239 с.Denkert C., Liedtke C., Tutt A., von Minckwitz G. Molecular alterations in triple-negative breast cancer-the road to new treatment strategies. Lancet 2017;389(10087):2430–42. DOI: 10.1016/S0140-6736(16)32454-0André F., Zielinski C.C. Optimal strategies for the treatment of metastatic triple-negative breast cancer with currently approved agents. Ann Oncol 2012;23(Suppl 6):vi46–51. DOI: 10.1093/annonc/mds195Lehmann B.D., Bauer J.A., Chen X. et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest 2011;121(7):2750–67. DOI: 10.1172/JCI45014Yang F., Xiao Y., Ding J.H. et al. Ferroptosis heterogeneity in triple-negative breast cancer reveals an innovative immunotherapy combination strategy. Cell Metab 2023;35(1):84–100.e8. DOI: 10.1016/j.cmet.2022.09.021Lehmann B.D., Pietenpol J.A. Identification and use of biomarkers in treatment strategies for triple-negative breast cancer subtypes. J Pathol 2014;232(2):142–50. DOI: 10.1002/path.4280Gibson G.R., Qian D., Ku J.K., Lai L.L. Metaplastic breast cancer: clinical features and outcomes. Am Surg 2005;71(9):725–30. PMID: 16468506Bertucci F., Finetti P., Cervera N. et al. Gene expression profiling shows medullary breast cancer is a subgroup of basal breast cancers. Cancer Res 2006;66(9):4636–44. DOI: 10.1158/0008-5472.CAN-06-0031Hayes M.J., Thomas D., Emmons A. et al. Genetic changes of Wnt pathway genes are common events in metaplastic carcinomas of the breast. Clin Cancer Res 2008;14(13):4038–44. DOI: 10.1158/1078-0432.CCR-07-4379Von Minckwitz G., Schneeweiss A., Loibl S. et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol 2014;15(7):747–56. DOI: 10.1016/S1470-2045(14)70160-3Sikov W.M., Berry D.A., Perou C.M. et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance). J Clin Oncol 2015;33(1):13–21. DOI: 10.1200/JCO.2014.57.0572Shepherd J.H., Ballman K., Polley M.C. et al. CALGB 40603 (Alliance): long-term outcomes and genomic correlates of response and survival after neoadjuvant chemotherapy with or without carboplatin and bevacizumab in triple-negative breast cancer. J Clin Oncol 2022;40(12):1323–34. DOI: 10.1200/JCO.21.01506Geyer C.E., Sikov W.M., Huober J. et al. Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase III trial. Ann Oncol 2022;33(4):384–94. DOI: 10.1016/j.annonc.2022.01.009Loibl S., OʼShaughnessy J., Untch M. et al. Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial. Lancet Oncol 2018;19(4):497–509. DOI: 10.1016/S1470-2045(18)30111-6Gray R., Bhattacharya S., Bowden C. et al. Independent review of E2100: a phase III trial of bevacizumab plus paclitaxel versus paclitaxel in women with metastatic breast cancer. J Clin Oncol 2009;27(30):4966–72. DOI: 10.1200/JCO.2008.21.6630Earl H.M., Hiller L., Dunn J.A. et al. Efficacy of neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin, and cyclophosphamide, for women with HER2-negative early breast cancer (ARTemis): an open-label, randomised, phase 3 trial. Lancet Oncol 2015;16(6):656–66. DOI: 10.1016/S1470-2045(15)70137-3Nahleh Z.A., Barlow W.E., Hayes et al. SWOG S0800 (NCI CDR0000636131): addition of bevacizumab to neoadjuvant nab-paclitaxel with dose-dense doxorubicin and cyclophosphamide improves pathologic complete response (pCR) rates in inflammatory or locally advanced breast cancer. Breast Cancer Res Treat 2016;158(3):485–95. DOI: 10.1007/s10549-016-3889-6Guarneri V., Dieci M.V., Bisagni G. et al. Preoperative carboplatin-paclitaxel-bevacizumab in triple-negative breast cancer: final results of the phase II Ca.Pa.Be study. Ann Surg Oncol 2015;22(9):2881–7. DOI: 10.1245/s10434-015-4371-0Kimbung S., Markholm I., Bjöhle J. et al. Assessment of early response biomarkers in relation to long-term survival in patients with HER2-negative breast cancer receiving neoadjuvant chemotherapy plus bevacizumab: results from the Phase II PROMIX trial. Int J Cancer 2018;142(3):618–28. DOI: 10.1002/ijc.31070Loibl S., Untch M., Burchardi N. et al. A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study. Ann Oncol 2019;30(8):1279–88. DOI: 10.1093/annonc/mdz158Loibl S., Schneeweiss A., Huober J. et al. Neoadjuvant durvalumab improves survival in early triple-negative breast cancer independent of pathological complete response. Ann Oncol 2022;33(11):1149–58. DOI: 10.1016/j.annonc.2022.07.1940Schmid P., Cortes J., Pusztai L. et al. KEYNOTE-522 Investigators. Pembrolizumab for early triple-negative breast cancer. N Engl J Med 2020;382(9):810–21. DOI: 10.1056/NEJMoa1910549Nanda R., Liu M.C., Yau C. et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: an analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol 2020;6(5):676–84. DOI: 10.1001/jamaoncol.2019.6650Mittendorf E.A., Zhang H., Barrios C.H. et al. Neoadjuvant atezolizumab in combination with sequential nab-paclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early-stage triple-negative breast cancer (IMpassion031): a randomised, double-blind, phase 3 trial. Lancet 2020;396(10257):1090–100. DOI: 10.1016/S0140–6736(20)31953-XGianni L., Huang C.S., Egle D. et al. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple-negative, early high-risk and locally advanced breast cancer: NeoTRIP Michelangelo randomized study. Ann Oncol 2022;33(5):534–43. DOI: 10.1016/j.annonc.2022.02.004Pusztai L., Yau C., Wolf D.M. et al. Durvalumab with olaparib and paclitaxel for high-risk HER2-negative stage II/III breast cancer: results from the adaptively randomized I-SPY2 trial. Cancer Cell 2021;39(7):989–98.e5. DOI: 10.1016/j.ccell.2021.05.009Eikesdal H.P., Yndestad S., Elzawahry A. et al. Olaparib monotherapy as primary treatment in unselected triple negative breast cancer. Ann Oncol 2021;32(2):240–9. DOI: 10.1016/j.annonc.2020.11.009