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Triple Negative Overview

x STRAIGHT TO SURGERY T2 and/or Clip Tumour & Node! DON'T FORGET... Paclitaxel Epirubicin Carboplatin Cyclophosphamide WLE OF CLIP TAD See Papers See Papers T1 See Papers See Papers > 2cm INITIAL STAGING NAC SURGERY Decision for Neoadjuvant chemotherapy (NAC) Response to NAC* FOOTPRINT ANC INCOMPLETE RESPONSE x ADJUVANT THERAPIES Pembroluzimab every 3 weeks to complete 9 cycles in total if received as NAC. See Papers BRCA status Olaparib See Papers gBRCA MUTATED NO MUTATION Capecitabine 6-8 Cycles See Papers ? Omit Rt In Future Watch This Space See Papers N+ ve x COMPLETE RESPONSE Pembroluzimab See Papers

Epirubicin

See Papers

Cyclophosphamide

See Papers

Paclitaxel

See Papers

Carboplatin

See Papers

Pembroluzimab

See Papers

Complete Response

Pembroluzimab every 3 weeks to complete 9 cycles in total if received as NAC.

See Papers

? omit RT
in future

watch this space

See Papers

Incomplete Response

gBRCA
MUTATED

Olaparib

See Papers

No mutation

Capecitabine
6-8 cycles

See Papers

Additional notes

*Pembroluzimab SEs include endocrinopathies – something to consider when operating on these patients!

BRCA testing for all patients under 60 years with TN and all under 40 with breast cancer.

See family history presentation – here