Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer Patients with nonmetastatic breast cancer Triple-negative breast HER2-negative and HR- HER2-positive disease cancer positive breast cancer Chemotherapy decision can be made without Clinically node-positive Node-positive or high-risk cT1a or cT1bN0 surgical pathology data T1aN0 and T1bN0 and/or at least T1c node-negative and/or tumor-specific genomic testing Endocrine therapy or Chemotherapy Neoadjuvant Should not be routinely Neoadjuvant Should not be routinely Neoadjuvant Neoadjuvant non- Postmenopausal patients Premenopausal patients chemotherapy may be offered neoadjuvant anthracycline- and offered neoadjuvant anthracycline- and anthracycline-based given in patients who are chemotherapy or anti- taxane- containing therapy outside a clinical taxane- containing regimen in combination candidates for adjuvant HER2 agents outside a regimen trial regimen with trastuzumab chemotherapy clinical trial Addition of carboplatin Neoadjuvant endocrine Should not be routinely Pertuzumab may be used after considering benefits therapy with an offered endocrine with trastuzumab and harms aromatase inhibitor therapy outside a clinical trial Abbreviations. HER2, human epidermal growth factor receptor 2, HR, hormone receptor Notes. Refer to the full guideline (Korde LA, Somerfield MR, Carey LA, et al: Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. Journal of Clinical Oncology: JCO.20.03399, 2021) to review reasons to use neoadjuvant therapy for patients with breast cancer This algorithm is derived from recommendations in Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breas t Cancer: ASCO Guideline. This is a tool based on an ASCO Guideline and is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines do not account for individual variation among patients. This tool does not purport to suggest any particular course of medical treatment. Use of the guideline and this tool are voluntary. www.asco.org/breast-cancer-guidelines ©American Society of Clinical Oncology 2021. All rights reserved. For licensing opportunities, contact [email protected].