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<p>Post-neoadjuvant therapy has become a&#xa0;cornerstone in the management of early triple-negative (TNBC) and HER2-positive breast cancer in patients with residual disease, who are at substantially increased risk of recurrence. In TNBC, the CREATE‑X trial established capecitabine as standard post-neoadjuvant therapy, while the benefit of prolonged adjuvant immune checkpoint inhibition after neoadjuvant chemo-immunotherapy remains controversial. Data from GeparNuevo and ongoing trials such as OptimICE-pCR challenge the need for post-neoadjuvant immunotherapy, particularly in patients achieving pathologic complete response (pCR). In HER2-positive disease, the KATHERINE trial established T‑DM1 (trastuzumab emtansine) as the post-neoadjuvant standard, and DESTINY-Breast05 recently demonstrated a&#xa0;marked reduction in recurrence risk with T‑DXd (trastuzumab deruxtecan), albeit with increased toxicity. Future strategies will increasingly focus on next-generation antibody–drug conjugates, such as sacituzumab govitecan in TNBC (SASCIA and ASCENT-05), and biomarker-guided risk stratification, including ctDNA (circulating tumor DNA), to personalize post-neoadjuvant treatment and avoid overtreatment.</p>

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Die postneoadjuvante Therapie des frühen Mammakarzinoms: Personalisierung als Schlüssel zur Prognoseverbesserung

  • 期刊论文

  • 发表日期：

    2026年4月9日

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  • Mattea Reinisch,
  • Anna-Lisa Spranger,
  • Rosalie König

摘要

Post-neoadjuvant therapy has become a cornerstone in the management of early triple-negative (TNBC) and HER2-positive breast cancer in patients with residual disease, who are at substantially increased risk of recurrence. In TNBC, the CREATE‑X trial established capecitabine as standard post-neoadjuvant therapy, while the benefit of prolonged adjuvant immune checkpoint inhibition after neoadjuvant chemo-immunotherapy remains controversial. Data from GeparNuevo and ongoing trials such as OptimICE-pCR challenge the need for post-neoadjuvant immunotherapy, particularly in patients achieving pathologic complete response (pCR). In HER2-positive disease, the KATHERINE trial established T‑DM1 (trastuzumab emtansine) as the post-neoadjuvant standard, and DESTINY-Breast05 recently demonstrated a marked reduction in recurrence risk with T‑DXd (trastuzumab deruxtecan), albeit with increased toxicity. Future strategies will increasingly focus on next-generation antibody–drug conjugates, such as sacituzumab govitecan in TNBC (SASCIA and ASCENT-05), and biomarker-guided risk stratification, including ctDNA (circulating tumor DNA), to personalize post-neoadjuvant treatment and avoid overtreatment.