Background: Triple-negative breast cancer (TNBC) is associated with a poor prognosis when compared to hormone receptor–positive breast cancers. Anthracycline-based regimens (ABRs) are mainstay for treatment of non-metastatic TNBC. However, anthracyclines are associated with an increased risk of potentially life-threatening adverse effects. We sought to evaluate outcomes in patients with early TNBC treated with ABRs versus those treated with anthracycline-sparing regimens (ASRs). Methods: All patients treated for stage I–III TNBC who had undergone curative-intent surgery at a large academic medical center between January 2013 and May 2018 were included in this retrospective study. Event-free survival (EFS) and disease-free survival (DFS) were the primary endpoints, with overall survival (OS) as a secondary endpoint and were defined as per standardized STEEP criteria. Kaplan–Meier, multivariable Cox regression, and log-rank tests were used to define key survival and treatment-related differences between subjects treated with ABRs versus ASRs. Results: One hundred thirty-two patients met inclusion criteria with a median follow-up of 55.9 months. Twenty-seven patients (20%) had disease recurrence and 20 (15%) died. Patients in the ABR group were more likely to have nodal involvement (chi-square p = 0.011). Patients treated with ABRs ( n = 26, 20%) compared with ASRs ( n = 106, 80%) had significantly shorter median EFS (32.4 months vs not reached (NR), p