Updates in Neoadjuvant Therapy for Triple Negative Breast Cancer

Neoadjuvant therapy in breast cancer refers to systemic therapy administered prior to definitive surgery. It was originally developed for patients with locally advanced breast cancer (stage III) with the intention of downstaging unresectable tumors, and decreasing the extent of surgical intervention, including axillary lymph node dissection. For patients with inflammatory breast cancer, neoadjuvant therapy is considered a standard of care. Increasingly, the neoadjuvant setting is being utilized to accelerate drug development and approval in triple negative breast cancer, a diverse and aggressive subgroup for which no approved targeted therapies are currently available. This review discusses the use of pathologic complete response as a clinical trial endpoint, the use of imaging and biomarkers to predict response to therapy, and standard of care treatment for triple negative breast cancer. Finally, we review novel targets and drug trials in the neoadjuvant setting.