How would you approach adjuvant systemic therapy for a patient with a history of localized triple negative breast cancer 7 years prior for which she received adjuvant AC-T, now presenting with another ipsilateral T1cN0 triple negative breast cancer?   

Although no one can be certain, given that most TNBCs would recur within the 3 to 5-year duration if this was a recurrence from the same clone, would be slim. Based on the CALOR trial, her local recurrence tumor would still benefit from adjuvant or neoadjuvant therapy. Based on the Sharma study, if ...

I would consider weekly carboplatin/paclitaxel based on a recent Phase III adjuvant trial compared with an anthracycline containing regimen in TN breast cancer, showing similar or better efficacy, or consider TC x4-6.