Would you give additional chemotherapy with taxane for a patient with triple negative breast cancer who has achieved pathologic complete response with Adriamycin and cyclophosphamide?

If there are no medical reasons to hold it and we believe the patient will tolerate it fairly well, I would give it.

A large metanalysis presented at SABCS showed no difference in outcome between patients who received extra chemo or did not, after pCR.

While these data give me comfort in omitting extra chemo in patients who may have a hard time with it (elderly, competing comorbidity), in the typical triple negative patient, I would still give the standard of care (other than on a clinical trial), absent level I evidence.

The data from the PROGECT study using neoadjvuant carboplatin/docetaxel in TNBC suggests that they do well when they attain a pCR without giving an anthracycline. (Sharma CCR 2018) It is apparent that regardless of the preoperative regimen used, adjuvant chemotherapy will be less likely to benefit pCR patients because they have very favorable outcomes. (Walsh BCRT 2019) Especially if they got it with an abbreviated ACx4 regimen since they likely had more chemosensitive disease. So I am pretty comfortable counseling patients about forgoing adjuvant chemotherapy if we had to stop their neoadjuvant therapy early for some reason but they got a pCR anyways.

The issue with this approach is you need to try and avoid getting a post op TNBC patient w...