Approach to systemic therapy in nonmetastatic triple-negative breast cancer (TNBC)

BRCA: breast cancer susceptibility gene.

* For clinical stage I cancers in whom the size or location of the breast tumor makes optimal primary surgery difficult, neoadjuvant chemotherapy without immunotherapy may be administered, followed by surgery. In such cases, if the patient does not experience a pathologic complete response (pCR), administration of adjuvant olaparib (in BRCA carriers) or adjuvant capecitabine (irrespective of BRCA status) can be considered.

¶ Surgical resection may include mastectomy or lumpectomy, depending on the location of the tumor, the patient's family history, and preferences. Lymph node evaluation is typically performed with a sentinel node biopsy, but an axillary dissection may be pursued if >2 lymph nodes are positive.

Δ In general, patients with microinvasive or very small (1 to 5 mm) tumors do not need chemotherapy, although some patients, particularly those with 4 or 5 mm tumors, may reasonably elect to proceed with treatment.