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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(02): 247-249
DOI: 10.4103/ijmpo.ijmpo_33_20
Courting Controversy

A Brief Review of Treatment Options for Neoadjuvant Chemotherapy in Patients with Triple-negative Breast Cancer

Akash Tiwari
Department of Medical Oncology, Shalby Hospital, Indore, Madhya Pradesh, India
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The index patient is a 40-year-old female with a strong family history (breast cancer in mother and ovarian cancer in maternal aunt) who presented with a 3-month history of breast lump. On examination, she had a 4 cm breast lump and fixed axillary nodes. Positron-emission tomography-computed tomography reveals no other site of disease. Core biopsy reveals high-grade invasive ductal cancer with triple-negative phenotype. Germ line testing is positive for the pathogenic BRCA1 mutation. She is well-educated and requests you to offer her the best possible treatment that can maximize her chances of cure and minimize her chances of relapse. At the same time, she would not like to go through unnecessary toxicity unless treatment intensification can improve her disease-free survival (DFS)/overall survival (OS).

After carefully considering her requests, you decide to offer her:

  1. Four cycles of two-weekly (adriamycin + cyclophosphamide) (AC) followed by four cycles of two-weekly paclitaxel

  2. Four cycles of two-weekly AC followed by 12 weeks of weekly paclitaxel

  3. Four cycles of two-weekly AC followed by 12 weeks of weekly nanoparticle albumin-bound -paclitaxel

  4. Four cycles of two-weekly AC followed by four cycles of paclitaxel with carboplatin

  5. Any other.

Triple-negative breast cancer constitutes 15%–20% of all breast cancer cases.[1] These tumors are a heterogeneous group, characterized by the lack of human epidermal growth factor receptor-2 (HER2)/neu, estrogen, and progesterone receptors. The absence of these predictive markers makes chemotherapy the primary treatment option for these tumors. Hence, we must choose a chemotherapy regimen that is most likely to benefit our patients in terms of survival.

The current case represents a scenario often faced in clinical practice. A significant proportion of these patients relapse and most of these relapses are within the 1st year of treatment. It is because of this problem that multiple treatment options have been studied in this select group. We will gradually dissect these options to conclude the best treatment option for the patient in question.



Publication History

Received: 31 January 2020

Accepted: 07 May 2020

Article published online:
23 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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