Do you have a certain tumor size threshold in which you change chemotherapy recommendations for a small, triple negative breast cancer?

Breast cancer death from small tumors is often underestimated. In 2000, 0.92%, 4.0%, and 10.7% breast cancer-specific deaths were due to T1a, T1b, and T1c node-negative cancers, respectively, which increased significantly to 1.9%, 5.8%, and 14.7% by 2017. This is an interesting read on death from small tumors: Marczyk et al., PMID 39348186.

Some patients will die from undertreatment, while death from overtreatment has never been shown in randomized adjuvant trials. Is 1:50 or 1:100 death acceptable to spare the rest from mostly manageable and variable-grade adverse events? (One needs to treat about 400 patients to induce an extra AML, Wolff et al., PMID 25534386)

The true toxicity differences between TC and weekly T/AC may be overstated. Ple...

This is often a subject of heated debate at our breast cancer conference. I tend to favor sequential use of weekly paclitaxel after AC for patients with node-negative TNBC, even if the tumor size is small. Higher proportional benefit has been demonstrated for the addition of a taxane after AC for patients with HR-negative tumors (Henderson et al., PMID 12637460), and to date, non-inferiority of non-anthracycline -containing regimens has not been established based on the ABC trial. Some of my colleagues, however, prefer to use TCx4 for TNBC <1cm. They argue that AC followed by paclitaxel may represent overtreatment for women with such small tumors and favor TC based on its superiority to ACx4 for women with early-stage breast cancer (Jones e...

For tumors equal to or smaller than 0.5 cm if pN0 no adjuvant therapy, if pN1mi consider adjuvant chemotherapy. (NCCN Category 2A) In select patients with tumors equal to or smaller than 0.5 cm with high-risk features (e.g., young patients with high-grade histology), adjuvant chemotherapy may be considered (NCCN Category 2B). The addition of 1 year of adjuvant Olaparib is an option for select patients with germline BRCA1/2 mutation after completion of adjuvant chemotherapy. (NCCN Category 2A)

As far as chemotherapy regimens, Paclitaxel + Carboplatin (various schedules) (NCCN Category 2A) or Docetaxel + Carboplatin (NCCN category 2A) are recommended.

There is no such thing as "small" TNBC to the extent that you can take a chance that a curable patient in adjuvant setting may have been a "missed opportunity" when either A or T is not used. This may not apply to neoadjuvant where one can offer TC before surgery and if residual disease is seen in surgery specimen, add Adriamycin.