Molecular and Clinicopathological Biomarkers Predicting Brain Metastasis in Triple-Negative Breast Cancer: A Systematic Review

Almost half of patients with triple-negative breast cancer (TNBC) develop brain metastasis (TNBCBM), a marker of poor prognosis. TNBC is a more aggressive breast cancer subtype which lacks ER, PR, and HER2 expression, and thus, exploring predictive biomarkers is crucial to improving TNBCBM outcomes through targeted therapy. To curate these biomarkers, peer-reviewed publications from 2010 to 2025 were extracted from PubMed, Scopus, Embase, Cochrane, and Web of Science if they evaluated clinicopathological biomarkers of TNBCBM. A total of 130 studies (60 clinical and 70 pre-clinical) were included. Publications most often featured transcriptomic studies, growth factor receptors, and immune microenvironment markers with 37, 19, and 17 studies identified, respectively. While TNBC aggressiveness has been linked to metastasis, advancing stage, and poor prognosis, several studies focused on utilizing circulating protein and transcriptomic biomarkers for early detection. While few pathways appeared specifically for TNBCBM, investigating these biomarkers further may allow for improved risk stratification, clinical trial design, patient selection, and therapeutic development. Identification of the most promising biomarkers will pave the way for improved prognosis of the most lethal complications of TNBC.