The study is generally of good quality, although it suffers from two weaknesses. The first is that the chemotherapy selected does not include carboplatin, a drug now considered crucial in triple-negative breast cancer. A second weakness is the study design: by not including a control arm without T-VEC [a type of oncolytic virus], the results are difficult to interpret. Most of the included patients are stage II, so it is not excluded that chemotherapy alone could show similar efficacy without the need for T-VEC.  

The main conclusion of the study is that T-VEC can be applied in combination with chemotherapy without serious toxicities, while paying attention to the risk of thrombosis, which nowadays can be easily prevented in patients at higher risk of these events. I believe that the results do not exclude further evaluation of the combination in a randomised study. The main problem for this is that, today, the standard pre-surgical therapy of triple negative breast cancer is no longer chemotherapy alone, but chemotherapy plus the immunotherapy pembrolizumab.  

Limitations of the study are the small sample size, the selection of a carboplatin-free chemotherapy and the absence of a randomised control arm without T-VEC.

The design of the work is of very good quality, with a very strong translational study. So far it provides evidence of a promising immunological response and phase 2 clinical activity for this combination, but not conclusive evidence of therapeutic benefit from the addition of T-VEX [oncolytic viruses] to this particular chemotherapy combination. 

The chemotherapy regimen used does not contain platinums, which are the most effective drugs in this clinical indication. In the future it would probably make sense to combine T-VEX with platinums and even immunotherapy, which is currently being developed with immune checkpoint inhibitors.

This is an article on the clinical efficacy of combination T-VEC virus and chemotherapy administered before surgery (neoadjuvant) for operable triple-negative breast tumours (non-metastatic). The rate of residual tumour at the time of surgery is assessed.  

The key is to know what response rates the same chemotherapy alone (without the virus) gives and whether the advantage provided by the virus is statistically significant. This should be assessed by an oncologist with expertise in triple negative breast cancer (I am a laboratory researcher). From what the authors say the rate obtained is higher, but due to the low number of patients nothing significant is reached and they only dare to say that the combination "may increase" the response rate, so I am afraid that an increase in the response rate is not demonstrated.