Dr. Brufsky on the Role of Neoadjuvant Chemotherapy in TNBC

Adam M. Brufsky, MD, PhD, a professor of medicine, associate chief in the Division of Hematology/Oncology, co-director of the Comprehensive Breast Cancer, and associate director of clinical investigation at University of Pittsburgh, discusses the role of neoadjuvant chemotherapy in triple-negative breast cancer (TNBC).

It is important to consider whether neoadjuvant therapy should be used in this population, according to Brufsky. As most patients with TNBC will require chemotherapy at some point during their treatment, it is acceptable to treat them with this approach up front, according to Brufsky; this provides several benefits. For example, neoadjuvant chemotherapy can help shrink large tumors, lead to less extensive surgery, and allow more time to prepare for surgeries like mastectomy or reconstruction. Additionally, if a patient has a family history of disease, this also allows for time to test for BRCA1/2 mutations and make surgical decisions accordingly.

Neoadjuvant therapy can also indicate whether the chemotherapy is effective in a patient, and can provide insight into whether another agent, such as capecitabine (Xeloda), is needed. Generally, neoadjuvant therapy is considered for tumors greater than 1 cm for patients with TNBC. Some practices will use this strategy for tumors that are 2 cm or T2, but neoadjuvant chemotherapy should be considered for tumors that are T1 and below, Brufsky concludes.