Would you offer systemic therapy before or after resection of an axillary-only recurrence of triple negative breast cancer?

I would most likely consider the neoadjuvant approach. - of course, few things to consider prior to making a decision.

1. How long was the duration between the previous completion of therapy for her first breast cancer? And was previous therapy complete, or rather was incomplete therapy was given?

2. Which agents were used in the previous setting?

3. Does her first cancer appear histologically and molecularly similar?

4. What are her PS, health status, age, and tolerance of previous chemotherapy?

The main reason to promote the use of neoadjuvant chemotherapy would be to assess the response to chemotherapy, which would likely predict the overall prognosis of the patient (although the recurrence this time could already indicate poor response)...

I agree with @Dr. First Last. The CALOR trial supports administration of chemotherapy in TNBC patients with a locoregional recurrence. Assuming there is no evidence that the axillary recurrence is biologically different from the breast primary, neoadjuvant chemotherapy will allow you to assess the sensitivity of the cancer to your chosen regimen, which may influence subsequent treatment - for example, would you consider administering adjuvant capecitabine (as in the CREATE-X trial) if the patient has a suboptimal response to your preoperative therapy? - as well as possibly limiting the extent of her axillary dissection, in a patient who presumably had axillary sampling if not a full ALND at the time of her initial surgery. Would also favor ...