Would you consider using anthracycline for treating a Stage I triple negative breast cancer in a patient with a baseline mildly reduced LVEF 50-55%?

I'm going to assume this is the clinical stage, and the patient has not yet had surgery. In this arena, if the patient is a fit surgical candidate then there are those who might advocate for taking to surgery up front if they are otherwise healthy. In patients like this, you could have a look at the lymph nodes and make sure they are truly negative and it might give you a better estimate of risk vs. benefit for the anthracycline. If small enough, I'd consider just using TC.

I think another reasonable option (if they are around 2cm and you want to test the waters) would be to discuss neoadjuvant therapy with Docetaxel plus Carboplatin. There are a number of studies now, such as the NeoCART trial (Zhang et al., JCO 2020) that are showing exce...

In contrast to the above responses, I generally avoid the use of either an anthracycline or TC (docetaxel and cyclophosphamide) in the treatment of stage I TNBC (including clinical stage I who, for whatever reason, we feel might benefit from neoadjuvant therapy). This is based on the results of the PATTERN trial (Yu et al., PMID 32789480), a 647-patient phase 3 trial that demonstrated that adjuvant paclitaxel and carboplatin, administered days 1, 8, and 15 every 28 days (for 6 cycles, though in my practice, stage I patients only get 4 cycles), was superior to FEC x 3 followed by docetaxel x 3 (5-yr DFS 86.5% vs.80.3%, HR 0.65, p=0.03), with similar improvements DFS and RFS, and with OS trending in the same direction (HR 0.71), with fewer ca...