How would you manage a patient who develops pleural and skin metastases shortly after completing neoadjuvant ddAC-T and surgery for a locally advanced triple negative breast cancer?

Any solid tumor refractory to frontline chemotherapy has three pathways moving forward:

1. Clinical trial

2. NGS on tissue to identify FDA approved targets (specifically BRCA in this case)

3. Standard second line therapies.

Under option 3: For PD-L1 > or = 1%, the combination of atezolizumab and nab-pac...

With pleural disease, this is definitively distant mets. I think this is important as sometimes those with local skin only recurrence can still be treated with curative intent. I would agree with testing for BRCA mutation for PARP inhibitor, genomic testing, and looking for clinical trials. If none ...

Do you think adding neoadjuvant immunotherapy would’ve helped? Thanks.

I agree with the above pathways. I would also like to add that if post-operative radiation has not yet been done, this would be a next viable option.

Capecitabine is a good option unless they are BRCA mutation positive, then I'd consider a PARP inhibitor.