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Early-Stage TNBC

CE / CME

Evolving Treatment Landscape for Early-Stage TNBC With and Without gBRCAm

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Pharmacists: 0.50 contact hour (0.05 CEUs)

ABIM MOC: maximum of 0.50 Medical Knowledge MOC point

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Released: June 26, 2026

Expiration: December 25, 2026

Kristen D. Whitaker
Kristen D. Whitaker, MD, MS
CME/CE Information

Activity

Progress
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Course Completed

Key Takeaways

Early and comprehensive biomarker and germline testing are essential in TNBC. ER, PgR, and HER2 status should be confirmed at diagnosis to ensure accurate classification, and germline testing should be completed early enough to inform treatment planning, hereditary risk assessment, and family counseling. For patients with TNBC, germline testing should not be limited only to those with a strong family history because clinically relevant pathogenic variants may be identified across age, racial, and ethnic groups.

Testing should also be broad enough to support current treatment decisions and hereditary risk assessment. Although BRCA1/2 status is especially important because it may inform eligibility for PARP inhibitor therapy in appropriate settings, multigene panel testing may identify other pathogenic variants, including PALB2, that can inform counseling, risk assessment, and selected clinical considerations. VUS should not be treated as pathogenic alterations for treatment selection, but patients may need follow-up with genetics counseling professionals if reclassification occurs.

Early-stage TNBC management is increasingly response-adapted. For patients with stage II/III TNBC who meet KEYNOTE-522-based criteria, pembrolizumab with neoadjuvant chemotherapy followed by adjuvant pembrolizumab is supported by phase III data demonstrating improvements in pCR, EFS, and OS.25,26 After surgery, treatment decisions are shaped by pathologic response, residual disease burden, prior pembrolizumab exposure, germline BRCA1/2 mutation status, toxicity risk, and patient preferences.9,10,18

For patients with residual invasive disease after neoadjuvant therapy, postneoadjuvant decision-making can be complex. Options may include continuing adjuvant pembrolizumab, using adjuvant olaparib for eligible patients with germline BRCA1/2-mutated, HER2-negative high-risk EBC, or considering capecitabine for selected patients with residual TNBC when PARP inhibitor therapy is not indicated. However, randomized comparative data have not established the optimal sequencing or combination of pembrolizumab, olaparib, and capecitabine across all clinical scenarios.

Shared decision-making is especially important when more than one reasonable treatment path may be considered. Discussions should include recurrence risk, biomarker and germline testing results, expected benefit and limitations of available evidence, treatment duration, toxicity profile, and patient goals.

Optimal TNBC care depends on timely diagnosis, accurate biomarker classification, early germline testing, coordinated multidisciplinary treatment planning, proactive toxicity management, and equitable access to evidence-based therapy and clinical trials. The goal is not only to select the right treatment, but also to help patients complete treatment safely and with clear understanding of the rationale, expected benefits, and potential risks. 

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