Optimal adjuvant treatment strategies for TNBC patients with residual disease after neoadjuvant treatment

ABSTRACT

Introduction

The therapeutic armamentarium for the neoadjuvant treatment of triple-negative breast cancer (TNBC) has significantly expanded with the hopes of improving pathological complete response (pCR) rates and the possibility of a cure. However, the data on optimal adjuvant treatment strategies for patients with residual disease after neoadjuvant treatment is limited.

Areas covered

We discuss the available data on adjuvant treatment for residual TNBC after neoadjuvant treatment considering clinical trials. Additionally, we discuss ongoing trials to give perspectives on how the field may evolve in the next decade.

Expert opinion

The available data support the use of adjuvant capecitabine for all patients and either adjuvant capecitabine or olaparib for patients with germline BRCA1 and BRCA2 mutations, according to availability. The CREATE-X study of capecitabine and OlympiA study of olaparib demonstrated disease-free and overall survival benefits. There is an unmet need for studies comparing these two options for patients with germline BRCA mutations. Further research is needed to delineate the use of immunotherapy in the adjuvant setting, molecular targeted therapy for patients with molecular alterations other than germline BRCA mutation, combinations, and antibody-drug conjugates to further improve outcomes.

KEYWORDS:

• Adjuvant
• capecitabine
• neoadjuvant
• residual disease
• pathological complete response
• olaparib

Article highlights

• The prognosis of patients with TNBC who do not achieve pathological complete response (pCR) with neoadjuvant chemotherapy is poor, and these patients are candidates for adjuvant treatment.

• Capecitabine improved survival in patients who do not achieve pCR after NACT for TNBC and is widely used in clinical practice for this indication.

• Olaparib is indicated for patients with TNBC who had residual disease after NACT and have a germline BRCA mutation.

• Data is limited regarding the comparison of capecitabine and olaparib for patients with BRCA mutations, as well as the possible benefit of the combined use of these two agents.

• Several ongoing studies are currently testing the benefit of capecitabine in combination with immunotherapy, as well as the use of antibody-drug conjugates as adjuvant treatment for residual disease after NACT for TNBC.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.