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?

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 ...

The additional toxicity of capecitabine would not be worth it, in my opinion. Outside of a trial, I would not do anything else.