Molecular Subtyping and Genomic Profiling Expand Precision Medicine in Refractory Metastatic Triple-Negative Breast Cancer: The FUTURE Trial

Triple-negative breast cancer (TNBC) is a highly heterogeneous disease, and molecular subtyping may result in improved diagnostic precision and targeted therapies. The FUTURE trial, a phase Ib/II subtyping-based and genomic biomarker-guided umbrella trial, enrolled and stratified patients by TNBC subtypes and genomic biomarkers. Patients with refractory metastatic TNBC were assigned to one of seven arms: (A) pyrotinib with capecitabine, (B) androgen receptor inhibitor with CDK4/6 inhibitor, (C) anti PD-1 with nab-paclitaxel, (D) PARP inhibitor included, (E) and (F) anti-VEGFR included, or (G) mTOR inhibitor with nab-paclitaxel. The immunotherapy arm (arm C) achieved the highest objective response rate (ORR; 52.6%). Arm E demonstrated favorable ORR (26.1%) but with more high-grade (≥ 3) adverse events.