In which patients with stage 1 triple negative breast cancer would you utilize neoadjuvant chemotherapy?

Overall, neoadjuvant administration of chemotherapy is appropriate whenever adjuvant chemotherapy is indicated. There is clinical benefit from administering chemotherapy to cancers > 2cm because patients are often end up with smaller surgical resection than in the absence of neoadjuvant chemotherapy...

I generally do not use neoadjuvant chemotherapy for cT1N0 TNBC. The goal for neoadjuvant systemic therapy is:

1. To convert a mastectomy into a lumpectomy
2. To downstage the disease in axilla
3. To deliver systemic therapy early
4. To assess response to therapy

None of the above aspects usually matter in a clinic...

One rule I live by is to avoid the temptation of giving neoadjuvant chemotherapy if the cancer is not palpable and thus hard to follow clinically. There is really very little reason to give neoadjuvant chemotherapy to small triple negative tumors, unless there is a clinical trial protocol.

Size does not matter in TNBC. The purpose of neoadjuvant chemo here is to see if the chemo chosen can eradicate residual disease, BCT being a side advantage. Those not achieving pCR should go on to chemotherapy, immunotherapy, and on trial. Small TNBC in the adjuvant setting is going to get standard...