Which neoadjuvant chemotherapy regimen would you use in a young, premenopausal woman with a rapidly growing clinical node positive poorly differentiated TNBC with a germline PALB2 mutation?

Options:

1) ddAC-T- surgery- adjuvant capecitabine if residual disease

2) weekly taxol/carbo x 12 followed by dd AC x 4

3) Keynote 522- pembro/taxol/carbo x 12 followed by pembro/AC x 4

Answer from: Medical Oncologist at Academic Institution

My preference is 2) weekly paclitaxel/carboplatin followed by AC, with adjuvant capecitabine if residual disease. There is no doubt that the addition of carboplatin increases the pCR rate in TNBC, and data from GeparSixto and patients on CALGB 40603 in whom doses of paclitaxel/carboplatin were not o...

Answer from: Medical Oncologist at Community Practice

Although purely speculative, would you add pembrolizumab just because of germline PALB2 mutation and inherent aberration in DNA repair? On similar lines, would platinum and I/O work synergistically in this situation? I hope molecular data from Keynote 522 sheds more light on this aspect.

Comments

Medical Oncologist at Warren Alpert Medical School of Brown University
TNBC patients with BRCA mutations are more likely ...

Medical Oncologist at NYU Winthrop Hospital
AC:-Taxane Good results as per NCCN guidelines.

Medical Oncologist at Senior Associate Consultant - Medical Oncology | Assistant Professor of Oncology
I agree with @William M. Sikov's approach except I...

Medical Oncologist at Warren Alpert Medical School of Brown University
I am not aware of any data in the literature suppo...

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Which neoadjuvant chemotherapy regimen would you use in a young, premenopausal woman with a rapidly growing clinical node positive poorly differentiated TNBC with a germline PALB2 mutation?

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