Exploring When to Use Neoadjuvant Treatment in TNBC

Adam M. Brufsky, MD, PhD, a professor of medicine and associate chief in the Division of Hematology/Oncology at the University of Pittsburgh School of Medicine, medical director of the Magee-Women’s Cancer Program, codirector of the Comprehensive Breast Cancer Center, and associate director for Clinical Investigations at the University of Pittsburgh Medical Center Hillman Cancer Center, discusses the use of neoadjuvant therapy for patients with triple–negative breast cancer (TNBC).

Since most of these patients are going to require chemotherapy at some point, their physicians have to decide whether they should get neoadjuvant therapy or not. Brufsky tells patients that if they have to get chemotherapy, they should most likely get it first. That allows multiple things to happen such as tumor shrinkage, which means surgery could be less extensive; if a mastectomy is required, neoadjuvant therapy gives the physicians time to prepare and get the surgery set up; and if the patient has a family history of cancer, it gives the physician time to test for BRCA1/2 mutations, which will help make decisions about surgery.

Additionally, neoadjuvant therapy allows physicians to see if the chemotherapy is working because if it doesn’t, then they can give the patient something different afterwards, according to Brufsky. If the tumor in a patient with TNBC is larger than 1 cm, then neoadjuvant therapy is considered.