The first 60 days: Early triple-negative breast cancer

Below, week by week, is what OnCo's record of Early triple-negative breast cancer says about the first two months: the order is typical, the timing is yours to ask about. Early triple-negative breast cancer is treated to cure. For tumours over 2 cm or with node involvement, chemotherapy plus the immunotherapy pembrolizumab before and after surgery has raised cure rates; BRCA carriers with cancer left at surgery add a year of olaparib, and others with residual cancer are offered capecitabine. Whether the tumour has vanished by surgery guides what comes next. Sections appear only where the record has something to say. Orientation, not medical advice.

Weeks 1 to 2

What happens now

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

Biomarkers your report may list

Oestrogen and progesterone receptor under 1 percent and HER2 0 to 1+, or 2+ without amplification Germline BRCA1, BRCA2 and PALB2 (olaparib eligibility, surgical choices)Tumour-infiltrating lymphocytes (prognostic, de-escalation trials)Pathological complete response and residual cancer burden at surgery PD-L1 (not required for pembrolizumab in early disease)Circulating tumour DNA after surgery (investigational)

Ask which of these were tested and what the results were; see the report reader for what each value means.

Tests and imaging linked to this cancer

Germline (hereditary) testing MRD / molecular residual disease testing

Weeks 1 to 3

Who is on your team

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Weeks 2 to 6

Decisions coming up

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1.Stage I, tumours 2 cm or less without node involvement
Surgery with sentinel node biopsy and radiotherapy; chemotherapy for tumours over 1 cm, often omitted below that, with tumour-infiltrating lymphocytes guiding de-escalation trials.
Lumpectomy (breast-conserving surgery)Sentinel lymph node biopsy Hypofractionated radiotherapy Tumour-infiltrating lymphocytes (TILs)
2.Stage II to III, before surgery
Pembrolizumab with carboplatin and paclitaxel, then with doxorubicin or epirubicin and cyclophosphamide, followed by surgery (KEYNOTE-522).
Pembrolizumab Carboplatin Paclitaxel / nab-paclitaxel Doxorubicin Epirubicin Cyclophosphamide KEYNOTE-522 Immune checkpoint inhibitors
3.After surgery, pathological complete response
Pembrolizumab to complete a year and radiotherapy by stage; omission of adjuvant pembrolizumab is under test (OptimICE-pCR).
Pembrolizumab Pathologic complete response (pCR)OptimICE-pCR (A012103)
4.After surgery, residual disease
Pembrolizumab to complete a year; olaparib for one year in germline BRCA carriers (OlympiA); capecitabine for six to eight cycles otherwise (CREATE-X); sacituzumab govitecan with pembrolizumab under study (ASCENT-05).
Pembrolizumab Olaparib OlympiA Capecitabine Residual cancer burden (RCB)ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)Germline (hereditary) testing
5.Local therapy
Breast conservation with whole-breast radiotherapy or mastectomy, sentinel node biopsy after neoadjuvant therapy, and post-mastectomy radiotherapy for node-positive disease.
Lumpectomy (breast-conserving surgery)Mastectomy Sentinel lymph node biopsy IMRT / IGRT (modern external beam)

Every visit

Questions to ask at each visit

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example Oestrogen and progesterone receptor under 1 percent and HER2 0 to 1+, or 2+ without amplification, Germline BRCA1, BRCA2 and PALB2, Tumour-infiltrating lymphocytes, Pathological complete response and residual cancer burden at surgery, PD-L1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Stage I, node-negative basal-like tumours of 2 cm or less, Stage II to III triple-negative disease, Germline BRCA1 or BRCA2-mutant early triple-negative disease.
Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.

Stage I, tumours 2 cm or less without node involvement

For my situation (stage i, tumours 2 cm or less without node involvement), which of the standard options do you recommend and why?Guideline options include: Surgery with sentinel node biopsy and radiotherapy; chemotherapy for tumours over 1 cm, often omitted below that, with tumour-infiltrating lymphocytes guiding de-escalation trials.

Stage II to III, before surgery

For my situation (stage ii to iii, before surgery), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab with carboplatin and paclitaxel, then with doxorubicin or epirubicin and cyclophosphamide, followed by surgery (KEYNOTE-522).
Am I a candidate for Pembrolizumab, Carboplatin, Paclitaxel / nab-paclitaxel or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of KEYNOTE-522 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

After surgery, pathological complete response

For my situation (after surgery, pathological complete response), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab to complete a year and radiotherapy by stage; omission of adjuvant pembrolizumab is under test (OptimICE-pCR).
Am I a candidate for Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of OptimICE-pCR (A012103) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

After surgery, residual disease

For my situation (after surgery, residual disease), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab to complete a year; olaparib for one year in germline BRCA carriers (OlympiA); capecitabine for six to eight cycles otherwise (CREATE-X); sacituzumab govitecan with pembrolizumab under study (ASCENT-05).
Am I a candidate for Pembrolizumab, Olaparib, Capecitabine, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of OlympiA and ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

Local therapy

For my situation (local therapy), which of the standard options do you recommend and why?Guideline options include: Breast conservation with whole-breast radiotherapy or mastectomy, sentinel node biopsy after neoadjuvant therapy, and post-mastectomy radiotherapy for node-positive disease.

Any stage

Are there clinical trials I could join, for example of ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63), OptimICE-pCR (A012103), SCARLET (SWOG S2212), MRD / molecular residual disease testing?Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
I read that “No trial has tested capecitabine or olaparib on top of adjuvant pembrolizumab for residual disease”. How does that affect my plan?Open problems are where trials and second opinions matter most.
I read that “About a third of patients do not reach a complete response and most relapses come from them”. How does that affect my plan?Open problems are where trials and second opinions matter most.

Weeks 3 to 8

Trials to ask about

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

From day one

Help that costs nothing

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

Any time

What to read next

Words this page and the cancer page use

Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point: When triple-negative breast cancer is still present at surgery after pre-operative chemotherapy and pembrolizumab, the amount left (the residual cancer burden) is what decides the next treatment: a year of olaparib for inherited BRCA carriers, capecitabine for others, pembrolizumab to complete the year, and trials of antibody-drug conjugates for everyone else.
Triple-negative breast cancer trials open today (registry snapshot and UK sites): Every phase 2 or 3 drug trial that was recruiting, about to open or still running for triple-negative breast cancer on ClinicalTrials.gov in September 2026, with the hospitals in the United Kingdom that take part named where the registry lists them.
Health disparities in cancer outcomes (ethnicity, deprivation and access): Health disparities are differences in who gets a cancer and who survives it that track ethnicity, income and access to care rather than chance.
Residual cancer burden (RCB): A pathology score for how much cancer remains in the breast and lymph nodes after pre-surgery treatment, from 0 (none) to III (a large amount), combining tumour bed size, cellularity and nodal involvement.
Homologous recombination deficiency (HRD) in breast cancer: Homologous recombination deficiency means a tumour cannot mend double-strand DNA breaks properly, most often because BRCA1 or BRCA2 is lost.
PD-L1 combined positive score 10 in triple-negative breast cancer: In metastatic triple-negative breast cancer the immunotherapy pembrolizumab is only given when a PD-L1 stain of the tumour scores 10 or more on the combined positive score, because that is the group in which the trial showed people lived longer.
ER and PR negative under 1 percent (the triple-negative threshold, and ER-low): A breast cancer counts as oestrogen receptor negative when fewer than 1 in 100 of its cells stain for the receptor, and the same rule applies to progesterone receptor.
Invasive disease-free survival (iDFS): Invasive disease-free survival is the yardstick of most trials that treat early breast cancer after surgery.
Tumour-infiltrating lymphocytes (TILs): Immune cells that have got inside the tumour.
Germline BRCA testing criteria for triple-negative breast cancer (UK): In the NHS a blood test for inherited BRCA1 and BRCA2 faults is offered to every woman under 50 with triple-negative breast cancer, whatever her family history, and hospital testing criteria now extend that to triple-negative disease under 60 and any breast cancer under 40.

Every term links to the glossary.