How can we integrate current adjuvant treatment options in triple negative patients with residual disease after neoadjuvant treatment?

Triple negative breast cancer (TNBC) accounts for approximately 12%–20% of all breast cancers but usually has a more aggressive clinical course and worse prognosis than hormone receptor expressing breast cancers. Locoregional treatments as well as systemic chemotherapy are part of the therapeutic algorithm in early breast cancer. Currently, neoadjuvant treatment is the standard for TNBC T1c N0 or higher. This strategy allows treating the disease early as well as selecting subsequent adjuvant treatment based on the pathological response achieved. Those patients with early-stage TNBC who have residual disease after completing neoadjuvant therapy have a higher risk of relapse and worse survival than those who achieve pathological complete response. Different drugs (capecitabine, pembrolizumab, olaparib) have so far demonstrated their benefit in the adjuvant setting after previous neoadjuvant treatment without being comparable because their clinical trials differ in design and study population. This scenario is therefore a clinical challenge where the selection criteria are fundamental to identify those patients who can benefit from each of the available therapeutic strategies.