# Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Source: https://onco.cc/key-papers/paper-asco-neoadjuvant-therapy-breast-guideline-jco-2021/  
OnCo record `paper-asco-neoadjuvant-therapy-breast-guideline-jco-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The US oncology society's 2021 rules for treatment before surgery: triple-negative tumours of 1 cm or more, or with involved nodes, should get anthracycline and taxane chemotherapy, carboplatin may be added, and at that date the evidence for adding immunotherapy was judged insufficient.

## Summary

ASCO guideline by Korde, Somerfield, Carey, Crews and colleagues, based on a systematic review of 41 articles. Patients on neoadjuvant therapy should be managed by a multidisciplinary team; candidates include inflammatory breast cancer and cases where residual disease would change therapy, and neoadjuvant treatment can reduce the extent of local therapy. Tumour histology, grade, stage and receptor status should guide decisions; other markers and genomic profiles lack evidence. Triple-negative patients with clinically node-positive or at least T1c disease should be offered an anthracycline- and taxane-containing regimen; cT1a or cT1bN0 disease should not routinely be offered neoadjuvant therapy; carboplatin may be offered to increase pathological complete response; evidence was insufficient to add immune checkpoint inhibitors. Hormone receptor-positive and HER2-positive recommendations are also given.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Journal of Clinical Oncology
- Year: 2021
- DOI: 10.1200/JCO.20.03399
- Authors: Korde LA, Somerfield MR, Carey LA, et al.
- Findings: Triple-negative, node-positive or at least T1c: offer anthracycline- and taxane-containing neoadjuvant chemotherapy; cT1a or cT1bN0: not routinely.; Carboplatin may be offered to increase pathological complete response.; Insufficient evidence in 2021 to add immune checkpoint inhibitors to neoadjuvant chemotherapy.
- What it means: The last major guideline written before KEYNOTE-522 changed the standard; the 2022 rapid update reversed the immunotherapy line within a year.
- Caveats: Superseded on immunotherapy by the 2022 rapid recommendation update.; Systematic review closed before the KEYNOTE-522 event-free survival data.

## Sources

- J Clin Oncol 2021: https://doi.org/10.1200/JCO.20.03399
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33507815/
- ASCO breast cancer guidelines: https://ascopubs.org/topics/asco-guidelines/breast-cancer

## Connected records

- key papers: [Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline](https://onco.cc/key-papers/paper-shelley-hwang-j-clin-oncol-2021/), [Use of Immune Checkpoint Inhibitor Pembrolizumab in the Treatment of High-Risk, Early-Stage Triple-Negative Breast Cancer: ASCO Guideline Rapid Recommendation Update](https://onco.cc/key-papers/paper-asco-pembrolizumab-early-tnbc-rapid-update-jco-2022/)
- cancers: [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Anthracyclines (doxorubicin, epirubicin)](https://onco.cc/terms/anthracycline/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Taxanes (paclitaxel, docetaxel, nab-paclitaxel)](https://onco.cc/terms/taxane/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)

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