Treatment
Measuring Response
➤ Patients receiving neoadjuvant therapy should be monitored for
response with clinical examination at regular intervals. Breast imaging
may be used to confirm clinical suspicion of progression and for surgical
planning. When imaging is used, the modality that was most informative
at baseline — mammography, ultrasound, or magnetic resonance
imaging — should be used at follow up. (Moderate recommendation;
IC-Ins)
➤ Blood- and tissue-based biomarkers should not be used for monitoring
patients receiving neoadjuvant therapy. (Strong recommendation; IC-Ins)
➤ pCR, defined as absence of invasive disease in breast and lymph nodes,
should be used to measure response to guide clinical decision making.
(Moderate recommendation; IC-Ins)
Recommended Regimens for Patients with TNBC
➤ Patients with TNBC who have clinically node positive and/or at least
T1c disease should be offered an anthracycline- and taxane-containing
regimen in the neoadjuvant setting. (Strong recommendation; EB-B-H)
➤ Patients with cT1a or cT1bN0 TNBC should not routinely be offered
neoadjuvant therapy outside of a clinical trial. (Strong recommendation;
EB-B-H)
➤ Carboplatin may be offered as part of a neoadjuvant regimen in
patients with TNBC to increase likelihood of pCR. The decision to offer
carboplatin should take into account the balance of potential benefits
and harms. (Moderate recommendation; EB-B-I)
➤ Neoadjuvant systemic therapy may be offered to reduce the extent of
surgery (breast conserving surgery [BCS]; axillary lymph node dissection,
ALND). Chemotherapy with or without targeted therapy, or endocrine
therapy (if HR+) may be offered. (Moderate recommendation; EB-B-I)
➤ In patients for whom a delay in surgery is preferable (e.g., for genetic
testing required for surgical treatment decision making, to allow time to
consider reconstructive options) or unavoidable, neoadjuvant systemic
therapy may be offered. (Moderate recommendation; IC-B-L)
