Locally Advanced and Metastatic Breast Cancer Post-Test

Post-Test: 20 items multiple choice and 5 items as modified true or false

1. In this trial, Pembrolizumab in combination with chemotherapy improved Progression

Free Survival in patients with previously treated locally recurrent unresectable or
metastatic TNBC, with tumors that express PD-L1.
A. KEYNOTE-522
B. KEYNOTE-355
C. KEYNOTE-086
D. KEYNOTE-357
2. JA, a 49-year-old premenopausal female, previously diagnosed with HR-positive Breast
Cancer Stage IIB, s/p right BCS followed by RT, currently on Tamoxifen for 4 years,
complains of a right breast mass. The following should be done to manage the patient,
EXCEPT:
A. Axillary lymph node dissection
B. Salvage mastectomy
C. Reirradiation with hyperthermia
D. Shift Tamoxifen to Letrozole and GnRh
3. Reasons for testing for germline BRCA 1 or 2 mutations in all patients with recurrent or
metastatic breast cancer, EXCEPT:
A. Olaparib is a category 1 recommendation for this subtype of patients
B. To identify candidates for PARP inhibition with talazoparib
C. Germline BrCA mutations are the only reliable predictive markers for Breast and
Ovarian Cancer
D. Carboplatin or cisplatin are the preferred options for chemotherapy in TNBC
4. A 52-year-old patient with HER2-positive metastatic breast cancer previously treated
with trastuzumab, pertuzumab, and trastuzumab deruxtecan now presents with
progressing brain metastasis on her most recent Cranial MRI. She has no headache,
seizures, changes in vision, or focal deficits. Based on the HER2CLIMB trial, the patient
may be started on Trastuzumab + Capecitabine + _____.
A. Lapatinib
B. Tucatinib
C. Neratinib
D. Whole Brain RT
5. According to the results of the HER2CLIMB trial, the addition of the agent/intervention
in #4 led to____.
A. Improved PFS and OS
B. Improved DFS
C. Improved EFS
D. Improved PFS only
6. In breast cancer, the following tumors are associated with a lower chance of initial
metastasis to the bone, EXCEPT:
A. HR-negative
B. HER2-positive
 C. Lobular type
D. Ductal type
7. The patient with the highest risk of recurrence after systemic therapy and surgical
intervention:
A. 68-year-old female, LD, diagnosed with HR-positive HER2-negative Breast Cancer
Stage IIIA, who already underwent left mastectomy
B. 27-year-old KF, who achieved a pCR after neoadjuvant treatment of triple negative
breast cancer, which was previously staged at T4N1M0
C. ML, a 56-year-old female, who initially came in with a 5.7 cm right breast mass,
matted right axillary LN, with the ff histopathology result: ypT0ypN0
8. Which of the following statements regarding endocrine therapy in metastatic breast
cancer is FALSE?
A. In the SWOG 0226 trial, it was found that the combination of AI + Fulvestrant was
not superior to monotherapy in patients previously treated with Tamoxifen.
B. Addition of CDK4/6 inhibitors to second-line endocrine therapy significantly
improved PFS.
C. Resistance to multiple endocrine therapies is not an indication for chemotherapy.
D. First-line endocrine therapy is associated with 8-12 months of tumor control on
average.
9. The MONALEESA-7 trial, which included a study population of 672 _______ patients
with HR-positive, HER2-negative advanced breast cancer, concluded that first-line
treatment with _______ led to a median PFS of 24 vs 13 months, compared to placebo.
A. Pre-menopausal / Ribociclib with Goserelin + AI or Tamoxifen
B. Pre-menopausal / Palbociclib with Goserelin + AI or Tamoxifen
C. Post-menopausal / Ribociclib with AI
D. Post-menopausal / Palbociclib with AI
10. A 60-year-old ECOG 1 patient with Triple Negative Breast Cancer presents with persistent
headache. Her Cranial MRI shows 3 intracranial lesions worrisome for metastases. What
is the next best step in managing the patient?
A. Give Trastuzumab every 21 days as it is able to adequately cross the blood brain
barrier
B. Surgical excision of metastasis
C. Stereotactic radiosurgery
D. Start alpelisib
11. Factor/s associated with greater likelihood of response to Pembrolizumab in triple
negative metastatic breast cancer:
A. High levels of PD-L1 expression
B. Presence and frequency of lymphocytes infiltrating the tumor
C. Tumor mutational burden >10
D. All of the above
E. None of the above
12. Which of the following is TRUE?
 A. The results of the DESTINY-Breast01 trial, which included HER2-positive previously
treated advanced breast cancer patients, showed that trastuzumab emtansine had a
high level of clinical activity in these patients and a significant overall survival.
B. Trastuzumab deruxtecan is an antibody-drug conjugate, which involves a
microtubule inhibitor, while trastuzumab emtansine involves a topoisomerase
inhibitor.
C. The DESTINY-Breast03 trial, which compared trastuzumab emtansine and
trastuzumab deruxtecan, showed improved survival and a higher response rate in
patients treated with trastuzumab emtansine.
D. The DESTINY-Breast03 trial affirmed trastuzumab deruxtecan as the standard of
care for the second-line treatment of patients with HER-2 positive metastatic
breast cancer previously treated with trastuzumab.
13. A 38-year-old female presented with left breast erythema and edema. Which of the
following is true regarding her diagnosis?
A. IBC, compared with locally advanced breast cancer, are more likely to have a more
favorable prognosis.
B. The optimal systemic therapy for IBC is Doxorubicin + Cyclophosphamide, as
concluded by large randomized trials.
C. Sentinel LN dissection remains the gold standard for assessing ALNs among patients
with IBC.
D. Radiation therapy to the chest wall and the supraclavicular region is recommended
in IBC.
14. To define efficacy of therapy in phase 3 metastatic breast cancer, these are the measured
end points used in clinical trials, EXCEPT:
A. Overall Survival
B. Progression Free Survival
C. Time to Tumor Progression
D. Objective Response Rate
15. What advice should you give patients initiated on bisphosphonates for bone metastasis?
A. Steroid use is a risk factor for the development of osteonecrosis of the jaw while
on bisphosphonates.
B. Supplementation with Calcium 1200-1600mg/day and Vitamin D3 400-800 IU/day.
C. Strict compliance to bisphosphonate therapy every 12 weeks has been associated
with improved OS for patients with metastatic breast cancer.
D. Results from clinical trials support the use of bisphosphonate therapy for up to 3-5
years.

Modified True or False:

1. Every-3-week paclitaxel administration showed equal clinical benefits to weekly
paclitaxel administration in terms of time to tumor progression. (False)
2. Patients with TNBC and HR-negative breast cancer have a higher risk of developing brain
metastasis. (False)
 3. Some types of inflammatory breast cancers, especially ones that are node-negative and
ones that do not present with a palpable mass, may be managed with early mastectomy
followed by adjuvant chemotherapy and radiotherapy. (False)
4. All patients with locally advanced breast cancer, even those with a pathological complete
response to neoadjuvant chemotherapy, must be treated with post-mastectomy RT.
(True)
5. Due to the high-risk nature of locoregional recurrences in breast cancer, these cases are
treated with palliative intent. (False)

ANSWER KEY:
1. B
2. A
3. C
4. B
5. A
6. D
7. B
8. C
9. A
10. C
11. C
12. D
13. D
14. C
15. A