Post(neo)adjuvant treatment concepts-Possibilities for individualization

Systemic breast cancer treatment is currently based on the tumor subtype and the individual risk of recurrence. In the case of high-risk situations chemotherapy is usually administered, sometimes combined with targeted substances and preferably in the neoadjuvant setting. Due to the neoadjuvant concept, the response to treatment can be postoperatively assessed and post(neo)adjuvant treatment can be individually adapted. For triple negative tumors, in addition to post(neo)adjuvant treatment with capecitabine, new targeted substances, such as immune checkpoint inhibitors or in cases of BRCA germline mutations, the poly adenosine diphosphate ribose polymerase (PARP) inhibitor olaparib can be implemented. Patients with HER2 positive disease and nonpathological complete remission (pCR) are recommended to switch to trastuzumab emtansine (TDM1). In cases of hormone receptor positive HER2 negative tumors the cyclin-dependent kinases (CDK) 4/6 inhibitor abemaciclib and for those with BRCA germline mutations, the PARP inhibitor olaparib as post(neo)adjuvant escalation strategies are available.