How do you approach adjuvant therapy for a premenopausal patient with a pathologic BRCA1 mutation whose TNBC had a complete response to neoadjuvant chemotherapy except for an ITC in one LN?
How do you approach adjuvant therapy for a premenopausal patient with ypT0N0(i+) TNBC and has a BRCA1 mutation?
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This is technically a Stage 0/RCB-I after neoadjuvant chemo when I calculated it. This patient would not qualify for the current clinical trials looking at additional therapy (ECOG capecitabine vs platinum, now closed; the SWOG pembrolizumab vs observation, still accruing). Looking at CREATE-X, the manuscript says "We recruited patients who had HER2-negative breast cancer of stage I through IIIB and pathologically assessed residual cancer cells (no pathological complete response) after neoadjuvant chemotherapy with anthracycline, taxane, or both" which I would interpret to mean that this patient would also have been excluded from that trial.
Thus, I would not offer adjuvant therapy with capecitabine based on this as a standard-of-care.
The additional toxicity of capecitabine would not be worth it, in my opinion. Outside of a trial, I would not do anything else.