Advances in immunotherapy for triple-negative breast cancer: Current indications, therapeutic response and impact on survival
DOI:
https://doi.org/10.62827/fb.v27i9.1356Keywords:
Triple Negative Breast Neoplasms; Immunotherapy; Survival; Pathological Complete Response.Abstract
Introduction: Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous subtype lacking hormone-receptor and HER2 targets. Immune-checkpoint inhibition has reshaped systemic treatment in high-risk early disease and biomarker-selected advanced disease. Objective: To analyze advances in TNBC immunotherapy, focusing on current indications, therapeutic response, survival and safety. Methods: An integrative review was performed with searches on September 27, 2026, in PubMed/MEDLINE, Scopus and Web of Science. Primary clinical studies in adults with TNBC reporting clinical efficacy, response, survival or safety outcomes were eligible; findings were synthesized narratively. Results: A total of 610 records were identified (198, 205 and 207, respectively); after removal of 112 duplicates, 498 records were screened and 22 full-text publications were assessed. Eighteen publications were included in the synthesis, corresponding to 15 independent clinical trials. In high-risk early TNBC, KEYNOTE-522 established consistent benefit for pembrolizumab combined with neoadjuvant chemotherapy and continued after surgery, improving pathological complete response, event-free survival and overall survival. Other neoadjuvant atezolizumab and durvalumab trials yielded heterogeneous results, whereas adjuvant-only atezolizumab or avelumab strategies did not show unequivocal disease-free survival benefit. In metastatic disease, pembrolizumab plus chemotherapy prolonged survival in PD-L1 CPS≥10 tumors; atezolizumab results varied according to chemotherapy backbone and biomarker; toripalimab plus nab-paclitaxel improved outcomes in PD-L1-positive disease; and in 2026 sacituzumab govitecan plus pembrolizumab prolonged progression-free survival in first-line PD-L1-positive disease. Conclusion: Immunotherapy is now a central component of TNBC management, but benefit depends on disease stage, timing, biomarker selection, systemic partner and toxicity profile. Among the included studies, pembrolizumab showed consistently favorable results in high-risk early TNBC and PD-L1 CPS≥10 advanced disease, while newer combinations continue to expand the therapeutic landscape.
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Copyright (c) 2026 Eberson da Silva Rodrigues do Nascimento, Larissa Bruner Oliveira Corrêa, Bruno Henrique Nakagawa, Bruna Tifani Bitzcof, Renato Discacciati (Autor)
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