Neoadjuvant therapy for triple negative and HER2-positive early breast cancer

Today, neoadjuvant therapy can be considered a therapy standard in triple negative (TNBC) and in HER2-positive (HER2+) (particularly in HER2+ HR-) early breast cancer (EBC). Patients with a pathological complete response (pCR) will have a very favorable outcome. In TNBC, chemotherapy with anthracyclines and taxanes is standard. Data regarding addition of bevacizumab are rather heterogeneous. Addition of carboplatin improves pCR rates independent of BRCA status; whether this will translate into a survival benefit is still unclear. In HER2-positive (HER2+) disease, anti-HER2 antibody therapy with trastuzumab is given together with chemotherapy. For patients at high risk of relapse, dual HER2 blockade with trastuzumab and pertuzumab is standard. The chemotherapy backbone consists either of an anthracycline-taxane sequence or of an anthracycline-free regimen such as docetaxel and carboplatin. pCR rates depend on hormone receptor (HR) status. Anti-HER2 therapy is completed after surgery with trastuzumab for a total of one year. Future research needs to focus on avoiding overtreatment in patients with pCR (de-escalation) as well as on improved therapy options (escalation) for patients with non-pCR after standard neoadjuvant therapy. Here, early response markers (e.g. biomarkers, molecular imaging) as well as novel targeted agents may play an important role in the future.