Systemic therapy

Neoadjuvant chemotherapy is the standard approach for patients with ≥T1c or N+ TNBC, as in this case. It allows for adjuvant treatments to be guided by the pathological response, which can improve survival, making it the preferred strategy^[1].

Evidence-based regimens without immune checkpoint inhibitors (ICIs) typically involve sequential therapies, such as anthracycline-based therapy followed by a taxane or a taxane–carboplatin sequence, with the order flexible. Importantly, the benefit of carboplatin is independent of gBRCA1/2 mutation status. Standard anthracycline-based regimens include doxorubicin–cyclophosphamide (AC) or epirubicin–cyclophosphamide (EC), administered over four cycles in 8 or 12 weeks, followed by a taxane over a similar course^[2].

Dose-dense therapies, including dose-dense AC or EC, combined with weekly paclitaxel, are preferred for their survival benefits. Adding carboplatin to the taxane enhances pathological complete response (pCR) rates and event-free survival (EFS), though its effect on overall survival (OS) is less defined^[3].