The first 60 days: Early triple-negative breast cancer
Early triple-negative breast cancer is treated to cure. For tumours over 2 cm or with node involvement, chemotherapy plus the immunotherapy pembrolizumab before and after surgery has raised cure rates; BRCA carriers with cancer left at surgery add a year of olaparib, and others with residual cancer are offered capecitabine. Whether the tumour has vanished by surgery guides what comes next. Below, week by week, is what OnCo's record of Early triple-negative breast cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Stage I, tumours 2 cm or less without node involvement, After surgery, residual disease, Local therapy.
- SurgeonNamed in the standard of care for: Stage I, tumours 2 cm or less without node involvement, Stage II to III, before surgery, Local therapy.
- Medical oncologistNamed in the standard of care for: Stage I, tumours 2 cm or less without node involvement, Stage II to III, before surgery, After surgery, pathological complete response, After surgery, residual disease and 1 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Stage I, tumours 2 cm or less without node involvement, After surgery, pathological complete response, Local therapy.
- Transplant and cell therapy teamNamed in the standard of care for: Stage II to III, before surgery.
- Palliative and supportive care teamNamed in the standard of care for: Stage II to III, before surgery.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Surgery with sentinel node biopsy and radiotherapy; chemotherapy for tumours over 1 cm, often omitted below that, with tumour-infiltrating lymphocytes guiding de-escalation trials.
Pembrolizumab with carboplatin and paclitaxel, then with doxorubicin or epirubicin and cyclophosphamide, followed by surgery (KEYNOTE-522).
Pembrolizumab to complete a year and radiotherapy by stage; omission of adjuvant pembrolizumab is under test (OptimICE-pCR).
Pembrolizumab to complete a year; olaparib for one year in germline BRCA carriers (OlympiA); capecitabine for six to eight cycles otherwise (CREATE-X); sacituzumab govitecan with pembrolizumab under study (ASCENT-05).
Breast conservation with whole-breast radiotherapy or mastectomy, sentinel node biopsy after neoadjuvant therapy, and post-mastectomy radiotherapy for node-positive disease.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Oestrogen and progesterone receptor under 1 percent and HER2 0 to 1+, or 2+ without amplification, Germline BRCA1, BRCA2 and PALB2, Tumour-infiltrating lymphocytes, Pathological complete response and residual cancer burden at surgery, PD-L1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Stage I, node-negative basal-like tumours of 2 cm or less, Stage II to III triple-negative disease, Germline BRCA1 or BRCA2-mutant early triple-negative disease.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Stage I, tumours 2 cm or less without node involvement
- For my situation (stage i, tumours 2 cm or less without node involvement), which of the standard options do you recommend and why?Guideline options include: Surgery with sentinel node biopsy and radiotherapy; chemotherapy for tumours over 1 cm, often omitted below that, with tumour-infiltrating lymphocytes guiding de-escalation trials.
Stage II to III, before surgery
- For my situation (stage ii to iii, before surgery), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab with carboplatin and paclitaxel, then with doxorubicin or epirubicin and cyclophosphamide, followed by surgery (KEYNOTE-522).
- Am I a candidate for Pembrolizumab, Carboplatin, Paclitaxel / nab-paclitaxel or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-522 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
After surgery, pathological complete response
- For my situation (after surgery, pathological complete response), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab to complete a year and radiotherapy by stage; omission of adjuvant pembrolizumab is under test (OptimICE-pCR).
- Am I a candidate for Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of OptimICE-pCR (A012103) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
After surgery, residual disease
- For my situation (after surgery, residual disease), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab to complete a year; olaparib for one year in germline BRCA carriers (OlympiA); capecitabine for six to eight cycles otherwise (CREATE-X); sacituzumab govitecan with pembrolizumab under study (ASCENT-05).
- Am I a candidate for Pembrolizumab, Olaparib, Capecitabine, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of OlympiA and ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Local therapy
- For my situation (local therapy), which of the standard options do you recommend and why?Guideline options include: Breast conservation with whole-breast radiotherapy or mastectomy, sentinel node biopsy after neoadjuvant therapy, and post-mastectomy radiotherapy for node-positive disease.
Any stage
- Are there clinical trials I could join, for example of ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63), OptimICE-pCR (A012103), SCARLET (SWOG S2212), MRD / molecular residual disease testing?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No trial has tested capecitabine or olaparib on top of adjuvant pembrolizumab for residual disease”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “About a third of patients do not reach a complete response and most relapses come from them”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)Phase 3 · active · NCT05633654Stage II to III TNBC with residual invasive disease after neoadjuvant therapy and surgery: adjuvant sacituzumab govitecan + pembrolizumab vs pembrolizumab ± capecitabine
- OptimICE-pCR (A012103)Phase 3 · recruiting · NCT05812807Stage II-III TNBC with pathologic complete response after KEYNOTE-522 regimen: adjuvant pembrolizumab vs observation
- SCARLET (SWOG S2212)Phase 3 · recruiting · NCT05929768Stage II-III TNBC: anthracycline-free carboplatin/docetaxel + pembrolizumab vs KEYNOTE-522 regimen
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Early triple-negative breast cancer: the full pageEarly triple-negative breast cancer is treated to cure. For tumours over 2 cm or with node involvement, chemotherapy plus the immunotherapy pembrolizumab before and after surgery has raised cure rates; BRCA carriers with cancer left at surgery add a year of olaparib, and others with residual cancer are offered capecitabine. Whether the tumour has vanished by surgery guides what comes next.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Tumour-infiltrating lymphocytes (TILs): Immune cells that have got inside the tumour.
- Residual cancer burden (RCB): A pathology score for how much cancer remains in the breast and lymph nodes after pre-surgery treatment, from 0 (none) to III (a large amount), combining tumour bed size, cellularity and nodal involvement.
- Pathologic complete response (pCR): No invasive cancer left in the breast and lymph nodes when the surgeon removes the tissue after pre-surgery treatment.
- Lumpectomy (breast-conserving surgery): Removing only the tumour with a rim of normal breast, keeping the breast; almost always followed by radiotherapy.
- Mastectomy: Removing the whole breast, either for cancer or preventively in BRCA1/2 carriers, where bilateral risk-reducing mastectomy cuts breast cancer risk by 90% or more.
Every term links to the glossary.