Mesrizadeh, Z.; Mukund, K.; Zabaleta, J.; Valle, L. D.; Tomsic, J.; Neuhausen, S. L.; Ding, Y. C.; Seewaldt, V.; Ochoa, A.; Miele, L.; Subramaniam, S.

The biological heterogeneity of triple-negative breast cancer (TNBC) poses significant challenges for diagnosis, prognosis, and treatment. While prior TNBC subtype classifications exist, they are not widely used clinically. Here, we aimed to subtype TNBC based on transcriptomic profiles using cell type and state heterogeneity in tumor tissue from 250 pre-treatment women (127 African-American and 123 European-American). We identified three major subtypes and three distinct groups exhibiting unique cell-type composition and mechanisms: Subtype-1 immune signaling/T-cell response; Subtype-2 pro-fibrotic and immune desert; Subtype-3 fatty acid and nuclear receptor signaling. Subtype-1 showed potential responsiveness to immunotherapy, while Subtypes-2 and 3 suggested alternative therapeutic targets. In Subtype-3, which contained a patient group with high ESR1, (but not high ER protein expression) we identified putative mutations in the gene that are unique to these patients. This framework provides a path toward personalized TNBC treatment and is accessible through a user-friendly RShiny application for clinical use.