Postneoadjuvant treatment for triple-negative breast cancer

Abstract

Purpose of reviewTriple-negative breast cancer (TNBC) has been conventionally associated with poor prognosis, as a result of limited therapeutic options. In the early setting, prognosis is informed by clinical–pathological factors; for patients receiving neoadjuvant treatments, pathological complete response (pCR) is the strongest factor. In this review, we mapped the landscape of clinical trials in the postneoadjuvant space, and identified three patterns of clinical trial design.Recent findingsFor patients at higher risk, effective postneoadjuvant treatments are of paramount importance to address a high clinical need. Postneoadjuvant risk-adapted treatments have demonstrated to improve survival in patients at high of recurrence.SummaryPatients at high risk have indication for adjuvant treatment intensification, informed by baseline clinical, pathological or molecular factors (type 1 approach), on the presence, extent and molecular characteristics of the residual disease at the time of surgery (type 2) or on risk factors assessed in the postsurgical setting (type 3), for example, circulating tumour DNA. Most of the past trials were based on type 2 approaches, for example, with capecitabine and Olaparib. Few trials were based on a type 1 approach, notably pembrolizumab for early TNBC. The clinical validity of type 3 approaches is under investigation in several ongoing trials.

Which Patients Do We Need to Test for BRCA1/2 Mutation? Feasibility of Adjuvant Olaparib Treatment in Early Breast Cancer–Real-World Data from Two Large German Breast Centers

“…As olaparib is an important treatment option for TNBC patients who carry gBRCA1/2 mutations and do not achieve a pCR after neoadjuvant chemotherapy, even more patients might have been eligible for adjuvant olaparib if all patients had received neoadjuvant chemotherapy. Other treatment options are available for patients who do not achieve a pCR [25]: according to the CREATE-X trial, postneoadjuvant capecitabine improves OS in patents with TNBC [26]. Moreover, the KEYNOTE-522 trial found that patients without a pCR will also benefit from the checkpoint inhibitor pembrolizumab.…”