Baseline → treatment → follow-up
When checks happen
Relative sequence, not booked dates or equal time intervals. Baseline ECG is distinct from risk-based echo. No routine three-monthly CT or echo is implied. The team books and reviews results.
| Check | Before starting | Phase 1 · weeks 1–12 | Before / during AC | Surgery / postoperative | After treatment |
|---|---|---|---|---|---|
| Blood tests | FBC, renal and liver; verify GFR | Weekly before planned doses | Before each 21-day AC cycle | Before each pembrolizumab cycle | Symptoms or abnormalities determine follow-up |
| ECG / echo | ECG and cardiac risk review; echo if indicated | Symptoms prompt earlier assessment | Review before first doxorubicin; further echo by risk / symptoms | Review any cardiac symptoms or previous abnormalities | Risk-based cardiac follow-up |
| Cancer imaging | Breast/nodal imaging; staging as indicated | Clinical response review; image for concern | Assess response and plan surgery | Pathology review; agree next steps | Breast surveillance; no routine CT/markers when asymptomatic |
| Thyroid / hormones | Thyroid baseline | Thyroid every 3–6 weeks | Continue immune monitoring | Continue while on pembrolizumab | Delayed immune symptoms still require review |
| Surgery / radiation | Agree overall MDT pathway | Systemic treatment first | Complete neoadjuvant phase if appropriate | Surgery → pathology → radiation if indicated | Follow-up and late-effect support |
The whole treatment journey
Pembrolizumab 200 mg + carboplatin AUC 5 / paclitaxel → AC: the whole pathway
Triple-negative breast cancer · neoadjuvant and adjuvant immunotherapy
Phase 1: four 21-day cycles; paclitaxel on Days 1, 8 and 15, carboplatin on Day 1. Phase 2: four AC cycles every 21 days. Pembrolizumab 200 mg every 21 days during chemotherapy; after surgery, nine 21-day doses or five 42-day doses (400 mg). See the whole-treatment map for monitoring and sequencing.
Read from left to right. Columns show stages, not equal lengths of time. This is a general plan: no dates or personal information are needed. Your team confirms which steps apply and arranges appointments.
On a small screen, swipe the map sideways. The checks below give the same timing in words.
| Care / check | Before starting | Phase 1 · weeks 1–12 | Before / during AC | Surgery / postoperative | After treatment |
|---|---|---|---|---|---|
| Cancer medicinesNCCP 00857 | Confirm diagnosis and suitability | Four 21-day cycles: weekly paclitaxel; carboplatin AUC 5 Day 1. Pembrolizumab each cycle Day 1. | Four AC cycles every 21 days. Pembrolizumab each cycle Day 1. | Surgery → pathology; pembrolizumab: 200 mg q21 days ×9 OR 400 mg q42 days ×5, if appropriate | Review late effects and follow-up |
| SurgeryEARLY · NEO | Discuss operation options | After systemic treatment | Plan after recovery | Lumpectomy or mastectomy as agreed | Surgical follow-up |
| RadiotherapyEARLY | Assess indication | Not a routine concurrent chemotherapy phase | Plan with surgery / radiation teams | After surgery if indicated; may overlap pembrolizumab if agreed | Late-effect review |
| Blood testsNCCP 00857 | FBC, renal and liver; verify GFR | Weekly before planned doses | Before each 21-day AC cycle | Before each pembrolizumab cycle | Symptoms or abnormalities determine follow-up |
| ECG / echoNCCP 00857 · ESC | ECG and cardiac risk review; echo if indicated | Symptoms prompt earlier assessment | Review before first doxorubicin; further echo by risk / symptoms | Review any cardiac symptoms or previous abnormalities | Risk-based cardiac follow-up |
| Imaging / markersEARLY · NEO | Breast/nodal imaging; staging as indicated | Clinical response review; image for concern | Assess response and plan surgery | Pathology review; agree next steps | Breast surveillance; no routine CT/markers when asymptomatic |
| Thyroid / hormonesNCCP 00857 | Thyroid baseline | Thyroid every 3–6 weeks | Continue immune monitoring | Continue while on pembrolizumab | Delayed immune symptoms still require review |
What each check is for
1Blood testsFBC, renal and liver tests weekly during the carboplatin/paclitaxel phase, then before every AC cycle. Continue the required blood tests before each postoperative pembrolizumab cycle.
Check safety before the planned dose.
Ask / act: Agree the booking owner, result reviewer and plan if delayed.
Sources: NCCP 00857
2ECG / cardiac reviewBaseline ECG and cardiac history/risk assessment. NCCP lists baseline echo/MUGA for age over 65 or when clinically indicated. Recheck the cardiac assessment before starting doxorubicin; echo/MUGA during treatment is driven by symptoms, risk or the agreed cardio-oncology plan. There is no automatic three-monthly echo schedule for every person on this pathway.
Check risk before and during anthracycline exposure.
Ask / act: Agree the booking owner, result reviewer and plan if delayed.
Sources: NCCP 00857 · ESC
3Cancer imagingRecord baseline breast/nodal findings and stage with imaging appropriate to the presentation. Assess clinical response during neoadjuvant treatment and use the appropriate breast imaging before surgery or sooner for concern. There is no universal three-monthly CT schedule for this early-breast pathway. After local treatment, arrange the agreed breast surveillance; routine CT/PET and tumour markers are not asymptomatic recurrence screening.
At the next review, ask
- Which treatment phase am I in, and what happens next?
- Which test is expected next, who arranges it, and who explains the result?
- Who should I contact if an expected appointment has not arrived?
This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.