Expert consensus recommendations on the daily clinical use of pembrolizumab for early triple-negative breast cancer

Neoadjuvant chemotherapy is a standard treatment for triple-negative breast cancer (TNBC) at an early stage. Given that pathological complete response is strongly associated with long-term clinical and survival benefits, the selection of appropriate treatment before and after surgery could further optimise treatment outcomes. With the emergence of immunotherapy in breast cancer, more combination treatment options are available, such as pembrolizumab, a programmed death receptor 1 inhibitor, which is approved for the perioperative treatment of stage II and III TNBC. However, the implementation of immunotherapy in perioperative settings for TNBC requires further discussion regarding patient selection and the use of different treatments in conjunction with immunotherapy. The Hong Kong Breast Cancer Foundation convened a multidisciplinary consensus panel consisting of surgeons, clinical oncologists, and medical oncologists to initiate this discussion. A modified Delphi panel was conducted, evaluating seven topics and 45 statements covering the workup and perioperative treatment of early-stage TNBC (eTNBC). The consensus statements provide guidance on determining whether a patient with eTNBC is a suitable candidate for neoadjuvant chemotherapy and immunotherapy.