How high a bar to change neoadjuvant therapy for triple-negative breast cancer?

Given the association between achievement of a pathologic complete response (pCR) and superior long-term outcomes in triple-negative breast cancer (TNBC), should the standard neoadjuvant regimen for TNBC be updated to reflect results from trials that report higher pCR rates with acceptable toxicity, or should any revision await demonstration of improvements in recurrence-free or overall survival? In this editorial, after reviewing pCR data from randomized trials assessing the addition of bevacizumab and/or carboplatin to standard neoadjuvant chemotherapy for TNBC, the authors discuss other goals of treatment, including the percentage of patients who can be offered breast-conserving surgery and in whom positive axillary nodes are cleared with treatment, which may influence treatment decisions in this setting.

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