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A manual search was conducted in the reference lists of selected articles, and relevant literature was included. Two investigators (OC and CS) independently searched the databases, using search terms mainly relating to neoadjuvant treatment in BRCA TNBC patients. Specific keywords and free text terms were combined with Boolean operators. The following search phrase was used: (breast OR mammary) AND (cancer OR cancers OR tumor OR neoplasm OR carcinoma) AND (BRCA) AND (neoadjuvant chemotherapy OR induction chemotherapy OR pre-operative chemotherapy) AND (TNBC OR triple-negative OR triple negative OR basal-like OR HER2 negative) AND (pathological complete response OR pCR), without any limits or restrictions. To be eligible, studies had to meet the following criteria: (1) prospective, retrospective or randomized clinical trial in patients with pathogenic BRCA mutated early TNBC; (2) must have enrolled BRCA TNBC patients receiving NACT; (3) must have provided data on pCR. We excluded (1) case reports, reviews, meta-analyses, animal, or in vitro studies; (2); ongoing studies with results not presented nor published at the time of the literature search.
pCR does not directly translate into long-term clinical outcomes; however, it is an important surrogate endpoint that implies low risk of residual disease within the breast and lymph nodes. Other positive effects of pCR are a greater proportion of patients achieving a negative sentinel node biopsy, reduction in the need for axillary lymph node dissection (ALND), increased disease-free survival and OS [35].
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