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🌱 來自: localized breast cancer

early-TNBC-ESMO-2023

TNBC

• HER2-negative tumours with 1%-9% ER and/or PgR expression (ER-/PgR-low) are a heterogenous group, some of which behave biologically similarly to TNBCs; therapeutic strategies should be adjusted to this specific situation since this might lead to a higher response to ChT and to reduced efficacy of ET compared with classical HR-positive breast cancer [II, B].

• TNBC tumours should be treated with ChT with or without an ICI (pembrolizumab) [I, A], except for some node-negative special histological subtypes such as secretory or adenoid cystic carcinomas or very low clinical risk (pT1a pN0) tumours [II, B].

• ChT should be administered for 12-24 weeks (4-8 cycles) depending on the stage of the disease, type of selected regimen and regardless of whether an ICI is added [I, A].

• The use of dose-dense schedules of ChT, with granulocyte colony-stimulating factor (G-CSF) support, should be considered given their documented benefit over non-dose-dense schedules [I, A].

• For cT1c-4 N0, or any N-positive TNBC, neoadjuvant treatment is preferred [I, A].

• cT2-4 N0 or any N-positive (stage II-III) TNBC should be treated with neoadjuvant ChT plus pembrolizumab unless there are risk factors for excessive ICI-associated immune toxicity [I, A; ESMO-MCBS v1.1 score: A].

• Pembrolizumab should be administered every 3 weeks throughout the neoadjuvant phase [I, A] and for nine 3-week cycles during the adjuvant phase, regardless of pCR status [I, A; ESMO-MCBS v1.1 score: A].

• Patients receiving pembrolizumab should be monitored very closely for the risk of immune-related adverse events throughout treatment and following the ESMO CPG for the management of toxicities from immunotherapy [V, A].107

• An ICI should not be given solely as adjuvant therapy without prior neoadjuvant ICI treatment [V, D].

• In patients with gBRCA1/2m and high-risk TNBC (non-pCR or pathological stage II-III), 1 year of adjuvant olaparib should be administered [I, A; ESMO-MCBS v1.1 score: A; ESCAT: I-A]. oThe combination of ICIs and olaparib may be considered on an individual basis [V, C].

• Patients with residual disease who did not receive ICIs should be offered adjuvant capecitabine for 6-8 cycles [I, A].

  • The combination of olaparib and capecitabine in patients with gBRCAm should not be used [I, E].
  • The combination of ICI and capecitabine may be considered on an individual basis [V, C].