61y female with bilateral breast cancers s/p upfront bilateral mastectomies, referral for adjuvant systemic therapy. Right breast - triple negative, pT1c pN0 Left breast - triple positive, pT1c pN0 Germline testing negative. Given TN histology, my plan would be to incorporate anthracycline based regimen (AC-T). With the HER2 positive component, she has a small tumor, node neg, hence plan to omit Pertuzumab. Preliminary plan is AC-TH, followed by trastuzumab maintenance, start AI after completion of chemo component. What would be your preferred regimen for adjuvant?
I think AC-TH is reasonable - but would also be fine with TCH (taxotere/carboplatin/herceptin) - this may be a bit safer from a cardiac perspective (given no anthracycline) and the taxotere/carboplatin regimen has been shown to be effective for TNBC in the Neo-STOP trial by Priyanka Sharma.
