Neoadjuvant therapy has become the standard of care in early-stage triple-negative breast cancer (TNBC), providing both prognostic information and a platform for treatment individualization. The achievement of a pathological complete response (pCR) is strongly associated with excellent long-term outcomes, whereas the presence of residual disease (RD) indicates a markedly increased risk of recurrence. This dual prognostic value has established post-neoadjuvant treatment as a critical arena for risk-adapted strategies. In patients achieving pCR, de-escalation of adjuvant therapy is under active investigation, with several randomized trials assessing whether surveillance may safely replace prolonged immunotherapy. Conversely, the management of patients with RD has become increasingly complex, as clinicians must navigate between established options such as capecitabine, olaparib, and pembrolizumab, while antibody-drug conjugates are likely to emerge as future therapeutic options in this high-risk setting. In parallel, locoregional approaches are evolving, with trials evaluating axillary de-escalation and even the omission of surgery in highly selected cases. Looking forward, the integration of biomarkers such as circulating tumor DNA and tumor-infiltrating lymphocytes may help refine these strategies, paving the way toward truly personalized post-neoadjuvant care in TNBC.
新辅助治疗已成为早期三阴性乳腺癌（TNBC）的标准治疗方案，不仅提供预后信息，也为个体化治疗提供了平台。病理完全缓解（pCR）的实现与良好的长期预后密切相关，而残留病灶（RD）的存在则提示复发风险显著增加。这种双重预后价值使得新辅助治疗后治疗成为风险适应性策略的关键领域。对于达到pCR的患者，辅助治疗降级策略正在积极研究中，多项随机试验正在评估是否可用监测安全替代长期免疫治疗。相反，对于存在RD的患者，管理策略日趋复杂，临床医生需要在卡培他滨、奥拉帕利和帕博利珠单抗等现有方案中进行选择，而抗体偶联药物有望成为这一高危人群未来的治疗选择。与此同时，局部区域治疗策略也在不断发展，相关试验正在评估腋窝降级治疗，甚至对高度筛选病例探索豁免手术的可能性。展望未来，循环肿瘤DNA和肿瘤浸润淋巴细胞等生物标志物的整合应用将有助于优化这些策略，为TNBC患者实现真正个体化的新辅助治疗后管理铺平道路。
Optimizing Post-Neoadjuvant Treatment in Early Triple-Negative Breast Cancer
肿瘤(癌症)患者之家