Chinese medicine-based interventions in triple-negative breast cancer: mechanistic evidence, clinical findings, and translational challenges-a narrative review.

Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous breast cancer subtype with early recurrence and limited therapeutic targets. The evidence reviewed here spans several non-equivalent intervention classes: licensed or commercial multi-component Chinese medicine products, standardized trial formulations, experimental botanical mixtures, and isolated constituents, fractions, or derivatives. We use the umbrella term Chinese medicine-based interventions (CMBIs) only for evidence mapping and do not assume pharmacological, manufacturing, or regulatory equivalence among these classes. Evidence was appraised on two independent dimensions: relevance to TNBC and study design/methodological robustness. TNBC-specific clinical evidence is limited to a small number of randomized and observational studies with dissimilar endpoints; a 2022 meta-analysis reported favorable pooled estimates but also substantial methodological weaknesses and intervention heterogeneity. Preclinical findings suggest pathway-associated effects involving apoptosis, ferroptosis, immune regulation, epithelial-mesenchymal transition, metabolism, and chemotherapy response. Ferroptosis evidence is currently limited to preclinical Shuganning injection studies showing iron-dependent lipid peroxidation and ferrostatin-1-sensitive cell death, without clinical validation in TNBC. Overall, CMBIs should be regarded as investigational adjunctive approaches rather than established TNBC-specific therapies. Priorities include product-level chemical characterization, clinically relevant exposure assessment, model-diverse causal validation, multicenter trials, and preparation-specific safety and interaction monitoring.