Shorter Chemo-Immunotherapy Without Anthracycline Drugs for Early-Stage Triple Negative Breast Cancer

Inclusion Criteria:

   - Participants must have histologically confirmed estrogen receptor (ER)-negative,
   progesterone receptor (PR)-negative, and HER2-negative breast cancer (TNBC) defined as
   ER < 5%, PR < 5%, and HER2 negative (per 2020 American Society of Clinical Oncology
   [ASCO] College of American Pathologists [CAP] guidelines)

      - NOTE: Participants with weakly ER or PR positive disease, defined as ER and/or PR
      between 1-4% by immunohistochemistry, are eligible if adjuvant endocrine therapy
      is not recommended/planned by the treating physician

   - Participants must have American Joint Committee on Cancer (AJCC) 8 anatomic tumor
   clinical stage either

      - T2-T4, N0, M0 or

      - T1-T3, N1-2, M0

      - Note: All participants with clinically suspicious nodes must undergo core needle
      biopsy or fine needle biopsy per standard clinical practice to pathologically
      confirm nodal status

   - Participants must have breast and axillary imaging with mammogram and/or ultrasound
   and/or magnetic resonance imaging (MRI) within 49 days prior to randomization

      - Note: Participants with bilateral invasive breast cancer are eligible if both
      breast cancers are ER-negative, PR-negative, and HER2-negative provided they meet
      the other eligibility criteria

   - Participants must not have T4/N+, any N3, or inflammatory breast cancer

   - Participants must not have metastatic disease (M1)

   - Participants must not have received prior systemic therapy or radiation therapy with
   curative intent for the current breast cancer

   - Participants must not have had previous definitive ipsilateral breast surgery for the
   current breast cancer

   - Participants must not have current or anticipated use of other investigational agents
   while participating in this study

   - Participants must not have history of allergic reactions attributed to compounds of
   similar chemical or biologic composition as study agents

   - Participants must not have severe hypersensitivity (>= grade 3) to pembrolizumab or
   any of its excipients

   - Participants must not have received prior therapy with an anti-PD-1, anti-PD-L1, or
   anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory
   T-cell receptor (e.g. CTLA-4, OX-40, CD137)

   - Participants must not be currently participating in or have participated in a study of
   an investigational agent or used an investigational device within 28 days prior to
   randomization

   - Participants must be >= 18 years old

   - Participants must have Zubrod performance status of 0-2

   - Participants with evidence of peripheral neuropathy must have it at =< grade 1, by
   Common Terminology Criteria for Adverse Events (CTCAE) version (v.) 5.0, within 28
   days prior to randomization

   - Participants must have a complete medical history and physical exam within 28 days
   prior to randomization

   - Hemoglobin >= 9.0 g/dL or >= 5.6 mol/L (within 28 days prior to randomization)

      - (Criteria must be met without erythropoietin dependency and without packed red
      blood cell transfusion within last 2 weeks)

   - Leukocytes >= 3 x 10^3/uL (within 28 days prior to randomization)

   - Absolute neutrophil count >= 1.5 x 10^3/uL (within 28 days prior to randomization)

   - Platelets >= 100 x 10^3/uL (within 28 days prior to randomization)

   - Total bilirubin =< 1.5 x institutional upper limit of normal (IULN), OR direct
   bilirubin =< IULN for participants with total bilirubin > 1.5 x IULN (unless history
   of Gilbert's disease. Participants with history of Gilbert's disease must have total
   bilirubin =< 5 x institutional IULN) (within 28 days prior to randomization)

   - Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x
   institutional upper limit of normal (ULN) (within 28 days prior to randomization)

   - Participants must have a serum creatinine =< the IULN OR calculated creatinine
   clearance >= 50 mL/min/1.73m^2 using the following Cockcroft-Gault Formula. This
   specimen must have been drawn and processed within 28 days prior to registration

   - Participants must have adequate cardiac function. Participants must have left
   ventricular ejection fraction >= 50% as assessed by either echocardiography (ECHO) or
   multigated acquisition scan (MUGA) assessed within 28 days prior to registration.
   Participants with known history or current symptoms of cardiac disease, or history of
   treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac
   function using the New York Heart Association Functional Classification and must be
   class 2B or better

   - Participants with known human immunodeficiency virus (HIV)-infection must be on
   effective anti-retroviral therapy at randomization and have undetectable viral load
   test on the most recent test results obtained within 6 months prior to randomization

   - Participants with evidence of chronic hepatitis B virus (HBV) infection must have
   undetectable HBV viral load while on suppressive therapy on the most recent test
   results obtained within 6 months prior to randomization, if indicated

      - Note: No testing for Hepatitis B is required unless mandated by local health
      authority

   - Participants with a history of hepatitis C virus (HCV) infection must have been
   treated and cured. Participants currently being treated for HCV infection must have
   undetectable HCV viral load test on the most recent test results obtained within 6
   months prior to randomization, if indicated

      - Note: No testing for hepatitis C is required unless mandated by local health
      authority

   - Participants with history of diabetes must not have uncontrolled diabetes in the
   opinion of the treating investigator

   - Participants must not have uncontrolled hypertension in the opinion of the treating
   investigator

   - Participants must not have had a major surgery within 14 days prior to randomization.
   Participants must have fully recovered from the effects of prior major surgery in the
   opinion of the treating investigator

   - Participants must not have severe or active infections within 14 days prior to
   Randomization, including but not limited to hospitalization for infection, bacteremia,
   or severe pneumonia

   - Participants must not have a diagnosis of immunodeficiency and be receiving chronic
   systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or
   any other form of immunosuppressive therapy within 7 days prior to randomization

   - Participants must not have active autoimmune disease that has required systemic
   treatment in 2 years prior to randomization (i.e., with use of disease modifying
   agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g.,
   thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or
   pituitary insufficiency) is not considered a form of systemic treatment

   - Participants must not have a history of (non-infectious) pneumonitis that required
   steroids, or has current (non-infectious) pneumonitis

   - Participants must not have received a live vaccine within 30 days prior to
   randomization. Examples of live vaccines include, but are not limited to, the
   following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever,
   rabies, Bacillus Calmette-Guerin (BCG), and typhoid vaccine. Seasonal influenza
   vaccines for injection are generally killed virus vaccines and are allowed; however,
   intranasal influenza vaccines (e.g., FluMist [registered trademark]) are live
   attenuated vaccines and are not allowed

   - Participants must not have a prior or concurrent malignancy whose natural history or
   treatment (in the opinion of the treating physician) has the potential to interfere
   with the safety or efficacy assessment of the treatment regimen

   - Participants must not be pregnant or nursing. Individuals who are of reproductive
   potential must have agreed to use an effective contraceptive method with details
   provided as a part of the consent process. A person who has had menses at any time in
   the preceding 12 consecutive months or who has semen likely to contain sperm is
   considered to be of "reproductive potential." In addition to routine contraceptive
   methods, "effective contraception" also includes refraining from sexual activity that
   might result in pregnancy and surgery intended to prevent pregnancy (or with a
   side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy,
   bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the
   semen

   - Participants must have one (1) physical 4-5-micron single hematoxylin and eosin (H&E)
   slide from the archival pretreatment diagnostic biopsy available for submission

   - Participants must be offered the opportunity to participate in specimen banking. With
   participant consent, specimens must be collected and submitted via the Southwest
   Oncology Group (SWOG) Specimen Tracking System

   - Participants who can complete questionnaires in English, Spanish, or French must be
   offered the opportunity to participate in the Patient-Reported Outcome study

   - NOTE: As a part of the Oncology Patient Enrollment Network (OPEN) registration process
   the treating institution's identity is provided in order to ensure that the current
   (within 365 days) date of institutional review board approval for this study has been
   entered in the system

      - Participants must be informed of the investigational nature of this study and
      must sign and give informed consent in accordance with institutional and federal
      guidelines

      - For participants with impaired decision-making capabilities, legally authorized
      representatives may sign and give informed consent on behalf of study
      participants in accordance with applicable federal, local, and Central
      Institutional Review Board (CIRB) regulations

   - As part of the registration process the treating institution's identity is provided in
   order to ensure that the current (within 365 days) date of institutional review board
   approval for this study has been entered in the system