Approaching Neoadjuvant Therapy in the Management of Early-Stage Breast Cancer

Figures & data

Table 1 Indications for Consideration of Neoadjuvant Chemotherapy

*Hormone-receptor positive breast cancer

High-risk HER2-positive breast cancer

High-risk triple-negative breast cancer

Inflammatory breast cancer

Locally advanced tumors breast cancers

Clinically node-positive breast cancers

Patients with contraindications to surgery including pregnancy or venous thromboembolism (VTE)

Delayed elective surgical plans due to pandemic or other elective procedures

Note: *In certain circumstances.

Figure 1 Treatment algorithm for adjuvant treatment in HER2+ patients.

Table 2 Neoadjuvant Trials in Triple-Negative Patients

Neoadjuvant Regimens with Carboplatin for Triple-Negative Breast Cancer
Trial	Phase	# of Patients	Investigational Arm	pCR (%) with Platinum vs without	EFS Improved
CALGB 40,603	2	443	T →AC + Bev	54 vs 41 (p=0.003)	No
BrighTNess	3	634	T ± V → AC	58 vs 31 (p<0.001)	NA
GeparSixto	2	595	T + A+ Bev	53 vs 43 (p=0.015)	Yes
GEICAM/2006-03	2	189	EC → T + Cb	30 in both arms	NA

Abbreviations: A, anthracycline; Bev, bevacizumab; C, cyclophosphamide; Cb, carboplatin; E, epirubicin; Nab-pac, nabpaclitaxel; pCR, pathologic complete response; T, taxane; V, veliparib.

Table 3 Neoadjuvant Trials with Immunotherapy in Triple-Negative Patients

Neoadjuvant Regimens with Immunotherapy in Triple-Negative Breast Cancer
Trial	Phase	# of Patients	Chemotherapy Regimen	Immune Checkpoint Inhibitor	pCR(%) with ICI Versus without
I-SPY2	2	250	T → AC	Pembrolizumab	60% vs 22%
KEYNOTE-522	3	602	Cb + T → AC	Pembrolizumab	65% vs 51% (p<0.001)
IMpassion031	3	333	Nab-pac → AC	Atezolizumab	58% vs 41% (p=0.004)
NeoTRIPaPDL1	3	280	Cb + Nab-pac	Atezolizumab	44% vs 41% (p=0.66)

Abbreviations: A, anthracycline; Bev, bevacizumab; C, cyclophosphamide; Cb, carboplatin; Nab-pac, nabpaclitaxel; pCR, pathologic complete response; T, taxane; V, veliparib.