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Review Open Access

Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review)

  • Authors:
    • Bingchen Li
    • Xinchen Tian
    • Qing-Qing Yu
    • Hongxia Cui
  • View Affiliations / Copyright

    Affiliations: Department of Clinical Medicine, Jining Medical University, Jining, Shandong 272000, P.R. China, Clinical Medical Laboratory Center, Jining No. 1 People's Hospital, Jining, Shandong 272000, P.R. China, Department of Oncology, Jining No. 1 People's Hospital, Jining, Shandong 272000, P.R. China
    Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 420
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    Published online on: July 21, 2026
       https://doi.org/10.3892/ol.2026.15775
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Abstract

Neoadjuvant therapy is the standard therapeutic entry point for the majority of stage II‑III triple‑negative breast cancer (TNBC) cases. However, a number of practical questions remain unresolved in daily care; specifically, it remains unclear how the balance between treatment intensification and toxicity can be maintained, how heterogeneous trial platforms should be interpreted and how biomarkers can be effectively applied without overextending their clinical role. The present review summarizes the currently available evidence on chemotherapy backbones, selective platinum intensification, perioperative immunotherapy, radiotherapy integration, response‑adapted strategies, post‑neoadjuvant treatment, circulating tumor (ct)DNA‑based residual‑risk assessment and emerging antibody‑drug conjugates. Anthracycline‑taxane chemotherapy remains the reference backbone for stage II‑III TNBC, whereas platinum is widely regarded as the selective intensifier in chemotherapy‑alone platforms. In addition, carboplatin forms part of the evidence‑based backbone of a KEYNOTE‑522‑like chemoimmunotherapy regimen. Among the immunotherapy strategies available, pembrolizumab‑based perioperative treatment has the most convincing evidence in terms of pathological complete response, event‑free survival and overall survival. Various biomarkers, such as programmed death‑ligand 1, stromal tumor‑infiltrating lymphocytes, homologous recombination deficiency, residual cancer burden and ctDNA, can improve biological and prognostic resolution. However, to the best of our knowledge few have been validated as stand‑alone treatment selectors. Therefore, future management protocols should remain evidence‑based, response‑aware and explicit regarding the boundary between established practice and investigational escalation.
View Figures

Figure 1

Evidence-based response-adapted
framework for stage II–III TNBC. The framework proceeds through six
linked decision points: i) Baseline confirmation of non-metastatic
stage II–III TNBC and recurrence risk; ii) selection of a
chemotherapy-alone or KEYNOTE-522-like chemoimmunotherapy backbone
according to eligibility and contraindications; iii) interim
response and toxicity assessment to determine whether the selected
pathway remains deliverable; iv) surgery and pathological response
evaluation using pCR and RCB; v) post-neoadjuvant risk
stratification integrating residual burden, nodal status, germline
BRCA1/2 status and ctDNA/MRD where available; and vi)
response-adapted postoperative treatment, including completion of
pembrolizumab, capecitabine, olaparib or trial-based
ADC/ctDNA-guided strategies as appropriate. TNBC, triple-negative
breast cancer; ICI, immune checkpoint inhibitor; AC,
doxorubicin-cyclophosphamide; EC, epirubicin-cyclophosphamide;
AC-T, anthracycline-taxane; pCR, pathological complete response;
RCB, residual cancer burden; ctDNA, circulating tumor DNA; MRD,
minimal residual disease; ADC, antibody-drug conjugate.
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Copy and paste a formatted citation
Spandidos Publications style
Li B, Tian X, Yu Q and Cui H: Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review). Oncol Lett 32: 420, 2026.
APA
Li, B., Tian, X., Yu, Q., & Cui, H. (2026). Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review). Oncology Letters, 32, 420. https://doi.org/10.3892/ol.2026.15775
MLA
Li, B., Tian, X., Yu, Q., Cui, H."Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review)". Oncology Letters 32.3 (2026): 420.
Chicago
Li, B., Tian, X., Yu, Q., Cui, H."Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review)". Oncology Letters 32, no. 3 (2026): 420. https://doi.org/10.3892/ol.2026.15775
Copy and paste a formatted citation
x
Spandidos Publications style
Li B, Tian X, Yu Q and Cui H: Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review). Oncol Lett 32: 420, 2026.
APA
Li, B., Tian, X., Yu, Q., & Cui, H. (2026). Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review). Oncology Letters, 32, 420. https://doi.org/10.3892/ol.2026.15775
MLA
Li, B., Tian, X., Yu, Q., Cui, H."Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review)". Oncology Letters 32.3 (2026): 420.
Chicago
Li, B., Tian, X., Yu, Q., Cui, H."Neoadjuvant therapy for stage II‑III triple‑negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review)". Oncology Letters 32, no. 3 (2026): 420. https://doi.org/10.3892/ol.2026.15775
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