Rishabh Jain, Medical Oncologist at AIIMS, shared a post on X:
“Stage I TNBC is not ‘low-risk by default.‘
We still treat by tumor size. But the real story is biology. Here’s where the field stands
Current approach (size-driven):
- T1mic/T1a – often no chemo
- T1b – surgery ± adjuvant chemo
- T1c – neoadjuvant chemo
Problem: Stage I patients were largely excluded from major trials. Biology is changing decisions.
High TILs:
- Excellent outcomes even without chemo
- Being tested in OPTImal, ETNA, TIL-CHOICE
Low TILs:
- Higher relapse risk despite small tumor
- May need escalation
Anthracycline debate (still unresolved):
- ABC trials – slight iDFS benefit
- PlanB / SUCCESS C – no OS benefit
- EBCTCG meta-analysis – modest recurrence reduction
Net: small gains vs real toxicity. Anthracycline-free strategies:
- PATTERN – Cb + taxane ↑ DFS
- NeoSTOP – similar pCR, less toxicity
- WSG-ADAPT-TN – response-adapted de-escalation
Immunotherapy + de-escalation:
- KEYNOTE-522 – standard in stage II–III
- NeoPACT, Neo-N – strong pCR signals
- SCARLET (ongoing) – testing chemo de-escalation
gBRCA subgroup:
- NEOTALA, OlympiaN, TBCRC 056: PARP inhibitor–based chemo-free strategies emerging.
Where we are going From: Tumor size alone To: Tumor size + TILs + genomics + ctDNA + response.”
Title: Stage I Triple-Negative Breast Cancer: Moving From One-Size-Fits-All to a Personalized Approach
Authors: Dame Idossa, Maeve A. Hennessy, Alexis LeVee, Rita Nanda, Heather McArthur, Roberto A. Leon-Ferre
Read the Full Article.
PREDICT sTILs: Bringing Immune Biology Into Chemotherapy Decisions for TNBC
