Abstract Triple negative breast cancer (TNBC) is accounts for approximately 10-15% of all breast cancer and is associated with a higher risk of disease recurrence, particularly early recurrence, than the other breast cancer subtypes. From a genomic standpoint, TNBC is heterogeneous, though we do not know how to incorporate this heterogeneity in treatment decisions. At the present time, there are no targeted systemic therapies for TNBC, and standard/neoadjuvant treatment consists of chemotherapy. Most treatment regimens include both an anthracyline and a taxane and involve 6-8 cycles of therapy, though simpler regimens such as AC x 4, TC x 4, or CMF x 6 remain an option for patients with a stage I disease. Neoadjuvant chemotherapy is often administered to decrease the extent of breast or axillary surgery. Outside of a clinical trial, anthracycline/taxane-based regimens remain the standard of care in the neoadjuvant setting. The addition of the platinum salts to standard therapy increases the proportion of patients who achieve a pathologic complete response, but it is unclear if these agents extend disease-free or overall survival. It is also unknown which patients benefit from the platinum salts and whether these agents should be added to or substituted for some portion of the standard regimen. Other investigational regimens, such as those including the PARP inhibitors, are also being studied in the neoadjuvant setting. On an individual patient level, response to neoadjuvant therapy is closely tied to outcome. Patients with a pathologic complete response have a far better outcome than those with residual disease, particularly those with extensive residual disease. However, it is unknown if the achievement of a higher pathologic complete response within a comparative trial leads to an improvement in disease-free or overall survival. Similarly, it is unknown if the addition of agents such as the platinum salts or other investigational treatmens can reduce the risk of recurrence in patients with residual disease after standard therapy. Ultimately, improved outcomes will be achieved through carefully controlled adjuvant and neoadjuvant trials conducted in close collaboration with laboratory investigators. It is likely that our understanding of the underlying biology of triple negative disease as well as our treatment approaches will evolve significantly in the next decade. Citation Format: Eric P. Winer. Adjuvant and neoadjuvant therapy: Current practice and future approaches [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr ES9-3.