Would you offer neoadjuvant chemotherapy to cT1c N0 triple negative breast cancer with metaplastic features in a young patient?

I would argue to proceed with neoadjuvant chemotherapy in this patient - as one could monitor anti-tumor response and offer capecitabine if residual disease. As not a T2 tumor, this patient does not fit the criteria for the KEYNOTE-522 regimen. One may also consider hereditary genetic testing for this patient.

In young-ish healthy patients, I have started to offer neoadjuvant chemo with close monitoring. I would typically with AC-T, as T1c was not enrolled on KEYNOTE-522 and these patients do not qualify for I-SPY. For those who might be questionable chemo candidates, I may push for surgery first and give TC post-operatively if indicated.