What chemotherapeutic regimen would you prefer in patients with T1N0 triple-negative breast cancer, assuming no contraindications to taxanes and anthracyclines?

In the joint analysis of the ABC (Anthracyclines in early Breast Cancer) presented at ASCO 2016 there was a 30% relative increased risk of invasive recurrence for women with ER/PR-negative, node-negative disease when an anthracycline was omitted (HR 1.31). Further subset analyses by tumor size were not provided, however, given the high risk of recurrence based on biology alone in this population I often recommend an anthracycline-taxane combination in my younger patients even in the setting of smaller tumors. I also now typically treat women with triple negative disease with neoadjuvant chemotherapy based on the growing body of data in support of downstream decision making about additional chemotherapy as informed by the presence of absence...

Although the relative risk reduction provided by anthracycline-based chemotherapy in triple negative breast cancer may be significant, on an absolute level, for a T1 N0 disease, it may be marginal. Such a marginal benefit is offset by quite significant toxicities. Therefore, in my practice, I generally recommend a non-anthracycline-based chemotherapy. However, I make it a point to discuss the risks and benefits in absolute terms, so that my patient can take an empowered decision - I believe in shared decision making. I have patients who have picked anthracycline-based therapy after such a discussion, and I respect it (unless I believe they may not tolerate it).