Breast cancer

Breast Cancer

Breast Cancer Part 1

Which non-anthracycline regimen can be used with Her2 positive breast cancer in the neoadjuvant
setting?

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Carboplatin plus paclitaxel

Breast Cancer Part 1
Breast cancer

What is the pathologic complete response rate with TCHP in the neoadjuvant setting for Her2 positive breast cancer?

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50%

Breast cancer
Breast cancer

How can you administer AC-THP for neoadjuvant breast cancer?

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AC x 4 every 2 weeks and then weekly taxanes plus Herceptin/Perjeta every 3 weeks

Breast cancer
Breast cancer

What percentage of breast cancer patients are hormone receptor positive?

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75%

Breast cancer
Breast cancer

When would you add albumin bound nanoparticle stabilized paclitaxel for breast cancer?

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In the setting of hypersensitivity
Steroid contraindications such as diabetes or psychosis

Breast cancer
Breast cancer

What are taxane infusion frequency options for neoadjuvant breast cancer?

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Paclitaxel every 7 days
Docetaxel every 21 days

Breast cancer
Breast cancer

When would you add pertuzumab to neoadjuvant breast cancer therapy?

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Tumor larger than 2 cm
Positive lymph node involvement

Breast cancer
Breast cancer

Which chemotherapy is generally avoided with Her2 positive breast cancer?

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Anthracyclines

Breast cancer
Breast cancer

What are 2 neoadjuvant regimens for breast cancers that are Her2 positive?

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TCHP every 3 weeks
Caboplatin weekly, taxane, + HP

Breast cancer
Breast cancer

Does hormone receptor positive or negative disease in the setting of positive Her2 status achieve
superior relapse free survival if complete pathologic response is achieved after neoadjuvant
chemotherapy?

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ER- has better outcomes

Breast cancer
Breast cancer

When would one use neoadjuvant treatment for stage I or stage II breast cancer?

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If patient desires a lumpectomy but would not be a good up-front candidate,

If the patient N1 disease but could spare axillary lymph node dissection if neoadjuvant is given,

If delay in surgery is expected for any reason

Breast cancer
Breast cancer

Which stage breast cancer should ideally get neoadjuvant chemotherapy regardless of Her2 status?

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T3 disease, stage III disease

Breast cancer
Breast cancer

What is unique about targeting Her2 in the neoadjuvant setting combined with chemotherapy?

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Very high pathologic complete response rates

Breast cancer
Breast cancer

Which patients benefit the most from pertuzumab in the adjuvant setting?

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Lymph node positive, hormone receptor negative

Breast cancer
Breast cancer

What is the difference between adjuvant chemotherapy recommendations for Her2 positive invasive
breast cancer that is less than or greater than 2 cm?

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Less than 2 cm taxanes plus trastuzumab
Larger than 2 cm, high risk, AC to TPH (ER-)
Large and in 2 cm low risk TCHP (ER+)

Breast cancer
Breast cancer

How do you treat primary breast cancer that is smaller than half a centimeter, lymph node negative,
hormone receptor negative, Her2 positive?

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Treat if the lesion is 3 mm or larger

Breast cancer
Breast cancer

What is the recommended adjuvant treatment for lymph node negative hormone receptor negative
Her2 positive tumors between 0.5cm and 2 cm ?

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Trastuzumab plus chemotherapy

Breast cancer
Breast cancer

When would you add pertuzumab to an adjuvant regimen containing trastuzuamb for breast cancer?

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Lymph node positive disease, primary lesion larger than 2 cm

Breast cancer
Breast cancer

In lymph node negative Her2 positive hormone receptor negative invasive breast cancer, what is the
smallest sized tumor that warrants the use of pertuzumab?

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1 cm

Breast cancer
Breast cancer

What does a PIK3CA mutation predicte in invasive breast cancer?

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Predicts for low response to trastuzumab

Breast cancer
Breast cancer

What is the value of estrogen receptor blockade in hormone receptor positive Her2 positive breast
cancer in the neoadjuvant setting ?

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No change in pathologic complete response with or without treatment, therefore equivocal

Breast cancer
Breast cancer

What is the role of neratinib in the neoadjuvant setting for Her2positive breast cancer?

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Low pathologic complete response versus the combination of paclitaxel plus trastuzumab

Breast cancer
Breast cancer

Does sclerosing adenitis predispose to breast cancer?

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Yes, twofold

Breast cancer
Breast cancer

Which non-invasive breast lesions will not develop into invasive breast cancer ?

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Ductal ectasia, cysts, fibroadenoma, mastitis, fibrosis

Breast cancer
Breast cancer

How do you treat Paget’s disease of the breast ?

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Mastectomy with axillary lymph node dissection

Breast cancer
Breast cancer

How do you treat a phyllodes tumor?

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Wide local excision

Breast cancer
Breast cancer

Can sentinel lymph node biopsy result in lymphedema?

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Yes

Breast cancer
Breast cancer

Which histologies of invasive breast cancer are favorable?

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Tubular and mucinous

Breast cancer
Breast cancer

What is the adjuvant endocrine therapy recommendation for men with breast cancer?

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Tamoxifen for 5 years

Breast cancer
Breast cancer

Is there are an overall survival advantage in combining a SERM and an AI?

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Yes

Breast cancer
Breast cancer

Is hypo-fractionated radiotherapy as efficacious as standard radiotherapy for breast cancer in the
adjuvant setting?

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Yes, equally efficacious

Breast cancer
Breast cancer

What size tumor warrants adjuvant chemotherapy for triple negative breast cancer?

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Greater than 0.5 cm.

Breast cancer
Breast cancer

How do you treat first-line metastatic triple negative breast cancer?

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Single agent paclitaxel or doublet chemotherapy if significant visceral crisis

Breast cancer
Breast cancer

For patients with IHC 1+ Her2, when do you order FISH?

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Grade 3 or very high Ki-67

Breast cancer
Breast cancer

What primary endpoint is not seen with neoadjuvant versus adjuvant breast cancer?

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Overall survival

Breast cancer
Breast cancer

Which subtype of breast cancer is most common with males?

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Hormone receptor positive Her2 negative, triple negative is very rare

Breast cancer
Breast cancer

What is the difference between medullary and infiltrating ductal carcinoma of the breast?

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Better prognosis with medullary but no change in chemotherapy recommendations

Breast cancer
Breast cancer

What are the criteria to consider BRCA testing?

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Male breast cancer in the family, male patient with breast cancer, Ashkenazi Jewish ancestry, primary
relatives with breast cancer younger than 50, personal history of ovarian fallopian peritoneal cancer, at
least 2 relatives with breast cancer, close blood relatives with epithelial ovarian cancer, younger than
age 45 at diagnosis, younger than age 50 and a primary relatives with breast cancer

Breast cancer
Breast cancer

Does a BRCA2 mutation cause endometrial cancer?

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No

Breast cancer
Breast cancer

Should women with dense breasts undergo breast MRI or mammogram?

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Mammogram

Breast cancer
Breast cancer

How do raloxifene and tamoxifen compare for postmenopausal women in preventing breast cancer or
ductal carcinoma in situ?

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Tamoxifen is superior

Breast cancer
Breast cancer

What subtype of breast cancer is most commonly seen in BRCA1 mutated patients?

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Triple negative

Breast cancer
Breast cancer

What is the value of tumor markers for surveillance in breast cancer?

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Use only during treatment in metastatic state and not in the adjuvant setting

Breast cancer
Breast cancer

How do you manage lobular or ductal hyperplasia of the breast in patients older than 60?

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exemestane preferred

Breast cancer
Breast cancer

What did the clinical trial OPTIMIZE-2 show for zoledronic acid in the context of skeletal related events
in metastatic breast cancer?

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Every 3 month dosing is the equivalent to monthly dosing

Breast cancer
Breast cancer

Is there are survival advantage with radiotherapy when only 3 lymph nodes in invasive breast cancer ?

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Yes

Breast cancer
Breast cancer

How is the management different for lobular carcinoma in situ versus ductal carcinoma in situ?

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Lobular carcinoma in situ – tamoxifen only no role for radiotherapy or lumpectomy

Breast cancer
Breast cancer

How do you manage DCIS status post mastectomy?

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Observation

Breast cancer
Breast cancer

What imaging is required at diagnosis for stage Ia to stage II B breast cancer diagnosis?

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No imaging required unless there are concerning signs, suspicious lymph nodes, elevated alkaline
phosphatase

Breast cancer
Breast Cancer Part 2

What black box warnings are there for TDM-1?

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Hepatic failure, pregnancy termination, cardiotoxicity

Breast Cancer Part 2
Breast cancer

What did the EMILIA clinical trial compare TDM-1 to in the early relapse setting?

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Capecitabine/lapatinib

Breast cancer
Breast cancer

What defines treatment free interval after prior trastuzumab exposure in the adjuvant setting for Her2
positive breast cancer?

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6 months, FDA definition
12 months expert definition

Breast cancer
Breast cancer

For women with stage IV Her2 positive breast cancer, after exhausting antibody directed therapy, what
available options are available besides standard chemotherapy?

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Lapatinib plus capecitabnie

Breast cancer
Breast cancer

For women with stage IV hormone receptor positive Her2 positive breast cancer, is the addition of
trastuzumab to an aromatase inhibitor superior to an aromatase inhibitor alone?

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Yes, the combination is superior

Breast cancer
Breast cancer

What did the PERTAIN clinical trial show?

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Superiority of T+P+AI vs T+AI

Breast cancer
Breast cancer

For women with hormone receptor positive Her2 positive premenopausal women, is an aromatase
inhibitor or SERM recommended?

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Aromatase inhibitor

Breast cancer
Breast cancer

How do you treat hormone receptor positive Her2 positive stage IV breast cancer in the premenopausal
setting?

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Same recommendations for chemotherapy and antibodies, but instead of SERM use GnRH inhibition
plus an aromatase inhibitor (also consider XRT or BSO)

Breast cancer
Breast cancer

When should you consider using trastuzumab alone without chemotherapy?

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If no visceral crisis, low volume disease, and patient is not desiring chemotherapy

Breast cancer
Breast cancer

For patients with stage IV hormone receptor positive Her2 positive breast cancer who have shown a
response to doublet antibody plus taxanes blockade, when would you add endocrine therapy?

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Complete the taxanes and then add an aromatase inhibitor

Breast cancer
Breast cancer

What defines Her2 positive breast cancer ?

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FISH ratio at least 2.0
Her2 copy # at least 6.0
Her2 IHC 3+

Breast cancer
Breast cancer

What percentage of breast cancer is stage IV at diagnosis?

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5%

Breast cancer
Breast cancer

If hormone receptor positive Her2 positive breast cancer patient does not have access to antibodies
targeting Her2 which agent should be used?

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Laptinib

Breast cancer
Breast cancer

What time frame is appropriate to re-challenge with pertuzumab/trastuzumab in the metastatic setting
?

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6 months- if greater than 6 months of stable disease or better then re-challenge
If less than 6 months, consider TDM-1

Breast cancer
Breast cancer

What first-line treatment of Her2 positive hormone receptor positive stage IV breast cancer should be
used if no prior Her2 therapy has been used?

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Pertuzumab/trastuzumab/taxane

Breast cancer
Breast cancer

How do you treat endocrine receptor positive Her2 positive stage IV metastatic breast cancer in the first
line?

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Presence of visceral crisis- chemotherapy plus Her2 targeted agent
No visceral crisis – hormone receptor blockade plus Her2 targeted agent

Breast cancer
Breast cancer

What percentage adherence to an aromatase inhibitor is required to minimize the effects on reduced
mortality?

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80%

Breast cancer
Breast cancer

Is there a proven role for sequential endocrine therapy following chemotherapy versus concurrent?

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No, only trend toward improved disease-free survival

Breast cancer
Breast cancer

Is there an increase in fractures at the 10-year versus 5-year mark for an aromatase inhibitor?

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Yes, 15% versus 10%

Breast cancer
Breast cancer

Is there an advantage to 10 years of an aromatase inhibitor use versus 5 years?

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Yes, increased disease-free survival but no improvement in overall survival

Breast cancer
Breast cancer

When can you see most of the benefit with an aromatase inhibitor?

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The first few years i.e. up the year 5

Breast cancer
Breast cancer

What 2 proven methods exist that lower disease-free survival for premenopausal women with breast
cancer after 5 years of SERM treatment?

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5 years SERM + 5 years AI is superior to 5 years of SERM
10 years of SERM is superior to 5 years of SERM

Breast cancer
Breast cancer

Who should get long-term endocrine treatment?

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High risk patients and low-risk patients with low side effect profile from therapy
What defines ovarian reactivation in premenopausal women taking an aromatase inhibitor?
High estradiol levels
Breakthrough bleeding

Breast cancer
Breast cancer

Who benefits the most from long-term endocrine therapy?

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High risk patients

Breast cancer
Breast cancer

What is the advantage of using exemestane versus anastrozole for post-menopausal women?

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None

Breast cancer
Breast cancer

What is one major risk for using an aromatase inhibitor in premenopausal women?

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Ovarian reactivation

Breast cancer
Breast cancer

What side effects are increased and decreased with an aromatase inhibitor versus SERM?

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Increase in osteoporosis, osteoporosis related fractures, cardiac disease, cholesterol levels
Decrease in thromboembolic events, endometrial cancer fatty infiltration of the liver

Breast cancer
Breast cancer

What is the sequence of treating an aromatase inhibitor musculoskeletal syndrome?

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Exercise then NSAIDs then duloxetine then consider switching to tamoxifen

Breast cancer
Breast cancer

How do you treat aromatase inhibitor-induced musculoskeletal syndrome?

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Exercise

Breast cancer
Breast cancer

What is the name for the arthralgia developed secondary to an aromatase inhibitor?

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AIMSS – aromatase inhibitor-induced musculoskeletal syndrome

Breast cancer
Breast cancer

What percentage of patients discontinue aromatase inhibitors secondary to arthralgias ?

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10- 20%

Breast cancer
Breast cancer

What are the major adverse events with tamoxifen?

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Deep venous thrombosis–pulmonary embolism
Questionable increased risk in arterial embolic disease including stroke
Questionable increase in uterine cancer

Breast cancer
Breast cancer

What are some long-term side effects with long-term ovarian suppression starting in premenopausal
women?

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Cardiac disease and decrease in bone mineral density

Breast cancer
Breast cancer

How do you treat postmenopausal women who cannot tolerate an aromatase inhibitor?

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Tamoxifen

Breast cancer
Breast cancer

What is the dosing of anastrozole, letrozole, exemestane in the adjuvant setting?

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Anastrozole 1 mg daily, letrozole 2.5 mg daily, exemestane 25 mg daily

Breast cancer
Breast cancer

Which premenopausal female patients should get GnRH plus aromatase inhibitor rather than
tamoxifen?

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High risk patient such as those requiring chemotherapy or those younger than age 35

Breast cancer
Breast cancer

Which subset of patients in the SOFT clinical trial on exemestane + GnRH did better with respect to five-
year progression free survival?

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Those that required chemotherapy, 91% versus 88%

Breast cancer
Breast cancer

How do you treat low risk premenopausal breast cancer patients with adjuvant endocrine therapy?

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Tamoxifen

Breast cancer
Breast cancer

What endocrine adjuvant treatment is recommended in high-risk premenopausal breast cancer
patients?

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Ovarian suppression plus exemestane

High risk disease defined as requiring chemotherapy, large tumor size, lymphovascular invasion, high-
grade, high recurrence risk score, age younger than 35

SOFT and TEXT trials

Breast cancer
Breast cancer

What are the formal definitions of postmenopausal state?

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Older than 60, amenorrheic for at least 12 months in the absence of chemotherapy or SERM blockade,
Bilateral oophorectomy, Concurrent use of SERM and both estradiol and FSH levels in the menopausal
range

Breast cancer
Breast Cancer Part 3

What is the preferred regimen for adjuvant breast cancer treatment?

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Dose dense Adriamycin plus cyclophosphamide followed by paclitaxel

Breast Cancer Part 3
Breast cancer

What regimen can be considered in the adjuvant setting for breast cancer in patients who cannot
tolerate anthracyclines or taxanes?

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CMF

Breast cancer
Breast cancer

Which patients can potentially avoid anthracyclines in the adjuvant setting for breast cancer?

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Endocrine receptor positive lymph node negative depending on RS score
Endocrine receptor negative lymph node negative, tumor smaller than 1 cm
Older patients
patients with congestive heart failure
Patients who are not willing to take the risk of heart failure or secondary malignancy

Breast cancer
Breast cancer

What RS-score predicts for adjuvant chemotherapy benefit in endocrine receptor positive Her2 negative
early-stage breast cancer ?

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Greater than 24-positive benefit
Less than 18 no benefit

Breast cancer
Breast cancer

What is the size cut-off for triple negative breast cancer before considering adjuvant chemotherapy?

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5 mm

Breast cancer
Breast cancer

Which 3 rare genetic mutations which are not tested for show an increased risk of breast cancer?

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CHEK2, PALB2, ATM

Breast cancer
Breast cancer

What is the correlation between Lynch syndrome and breast cancer?

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Unclear secondary to mixed studies

Breast cancer
Breast cancer

What histology of breast cancer is seen in patients with CDH1 gastric cancer?

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Lobular with diffuse gastric involvement

Breast cancer
Breast cancer

Which gastric cancer syndrome has an association with breast cancer ?

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CDH1

Breast cancer
Breast cancer

What is a lifetime risk of breast cancer for patients with Cowden syndrome?

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85%

Breast cancer
Breast cancer

What is a pathognomonic feature of Peutz-Jeghers syndrome?

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Hamartomatous polyps in the GI tract

Breast cancer
Breast cancer

Which gene is mutated in Peutz-Jeghers syndrome?

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SDK 11

Breast cancer
Breast cancer

What is the inheritance of BRCA1 and BRCA2?

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AD

Breast cancer
Breast cancer

Which 3 syndromes predispose to breast cancer?

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BRCA1, BRCA2, Li-Fraumeni syndrome, Cowden syndrome

Breast cancer
Breast cancer

When is the use of oral contraceptive pills in patients with a history of breast cancer appropriate?

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Never

Breast cancer
Breast cancer

When would use a bone scan, CT scan, PET scan for surveillance in breast cancer?

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Never, only if there are positive symptoms

Breast cancer
Breast cancer

What is the role of CEA, CA 27.29, CA 15–3 for breast cancer surveillance?

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Only monitoring during treatment in the stage IV setting

Breast cancer
Breast cancer

Who should get baseline DEXA scans ?

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Premenopausal patients with premature menopause secondary to treatment, age greater than 65, ages
60-64 with positive use of steroids, less than 70 kg, positive family history, risk factor for osteoporosis,
postmenopausal women wheezing an aromatase inhibitor

Breast cancer
Breast cancer

What is involved in the surveillance in patients that have had bilateral mastectomy?

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No imaging, physical exam only

Breast cancer
Breast cancer

What is the survival advantage of mammogram status post breast conservation therapy ?

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Lowers the risk of death from local recurrence as well as contralateral primary

Breast cancer
Breast cancer

After completing breast conservation therapy, how often should a mammogram be performed?

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Every 1 year

Breast cancer
Breast cancer

What is the recommended surveillance for breast cancer patients that were treated with curative intent
methods?

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Clinical exam every 4-6 months for the first 3 years then clinical exam every 6 months years 4-5 then
every 12mo after 5 years

Breast cancer
Breast cancer

What are 6 exclusion criteria for lumpectomy?

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Prior history of radiotherapy, multicentric disease, calcifications, high tumor to breast size ratio, positive
margins on second excision, pregnancy

Breast cancer
Breast cancer

What is the purpose of lumpectomy and radiotherapy versus mastectomy ?

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equal outcomes, cosmetic improvements, low risk of recurrence

Breast cancer
Breast cancer

What is the definition of breast conservation therapy ?

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Breast conservation surgery plus radiotherapy

Breast cancer
Breast cancer

What defines early and locally advanced breast cancer?

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Early–stage I, stage IIA, stage IIB (T2 N1)
Locally advanced–stage IIB, stage IIIA, stage IIIB, stage IIIC (T3 N0)

Breast cancer
Breast cancer

What is Paget’s disease of the breast ?

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Cancer of the nipple complex

Breast cancer
Breast cancer

How can you treat first trimester breast cancer in patients who will not undergo a pregnancy
termination?

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Mastectomy and second trimester chemotherapy
Only postpartum radiotherapy and endocrine therapy

Breast cancer
Breast cancer

For pregnant women with newly diagnosed breast cancer, when is radiotherapy or
endocrine therapy appropriate ?

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Only in the postpartum setting

Breast cancer
Breast cancer

How do you manage first trimester breast cancer?

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If termination is not an option, then surgery followed by adjuvant radiotherapy / chemotherapy and
endocrine therapy

Breast cancer
Breast cancer

What is the treatment pathway for inflammatory breast cancer ?

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Neoadjuvant chemotherapy with or without the addition of Her2 targeted therapy followed by
mastectomy and level I and 2 lymph node dissection as well as chest wall and supraclavicular
radiotherapy

Breast cancer
Breast cancer

What is the T stage for inflammatory breast cancer?

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T4d

Breast cancer
Breast cancer

What defines N1, N2, N3 for breast cancer?

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N1 – micrometastases to lymph nodes, 1-3 axillary lymph nodes involved, internal mammary lymph node
involvement
N2–4-9 axillary lymph nodes involved, internal mammary lymph nodes without axillary involvement
N3 > 9 axillary lymph nodes involved, Infraclavicular lymph node, contralateral internal mammary
lymph node, both internal mammary and axillary lymph nodes involved, Supraclavicular lymph node

Breast cancer
Breast cancer

What defines T1-T4 breast cancer?

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T1 less than 2 cm
T2 2 to 5 cm
T3 larger than 5 cm
T4 chest wall invasion or skin involvement

Breast cancer
Breast cancer

How would you designate a complete pathologic response on a pathology report post neo-adjuvant chemotherapy?

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ypT0 ypN0

Breast cancer
Breast cancer

Is there data to add a CDK 4/6 inhibitor following TDM1-, trastuzumab and pertuzumab in HR+ Her2+ metastatic breast cancer ?

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Yes – MONARCHER clinical trial – Abemaciclib added to trastuzumab and fulvestrant progressing on TDM-1

Breast cancer
Breast cancer

What can lapatinib be combined with?

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Capecitbaine and trastuzumab

Breast cancer
Breast cancer

Is lapatinib metabolized by the kidney or liver?

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liver

Breast cancer
Breast cancer

Should TDM-1 be used before or after lapatinib/capecitabine?

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Before

Breast cancer
Breast cancer

Can you continue trastuzumab in the background while changing chemotherapy in the metastatic
setting?

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Yes

Breast cancer
Breast Cancer Part 4

Did the EMBRACA trial enroll patients with Her2 positive disease ?

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View Question

No

Breast Cancer Part 4
Breast Cancer

What did the EMBRACA trial assess in BRCA mutated breast cancer ?

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Talzoparib versus monotherapy with eribulin or vinorelbine or capecitabine or gemcitabine

Breast Cancer
Breast Cancer

What did the OlympiAD trial assess in BRCA mutated breast cancer ?

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Olaparib versus monotherapy with eribulin or vinorelbine or capecitabine

Breast Cancer
Breast Cancer

What did the SOLAR-1 trial compare in breast cancer ?

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Alpelisib added to fulvestrant for HR+ PIK3CA mutated breast cancer

Breast Cancer
Breast cancer

what are some high risk features that warrant adjuvant radiotherapy following radical mastectomy in breast cancer ?

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T3 disease, T4 disease, T2 disease with less than 10 lymph nodes involved, high-grade tumors, hormone
receptor negative, positive lymphovascular invasion

Breast cancer
Breast cancer

Should you provide adjuvant radiotherapy for patients who have achieve a pathologic complete
response following neoadjuvant chemotherapy and modified radical mastectomy for breast cancer ?

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Yes, pCR does not change radiotherapy recommendations!

Breast cancer
Breast cancer

What lymph node stations are radiated following modified radical mastectomy ?

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Supraclavicular, infraclavicular, internal mammary, axillary only of no complete axillary lymph node
dissection

Breast cancer
Breast cancer

Involvement of how many lymph nodes warrant radiotherapy post modified radical mastectomy ?

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More than 3 – radiotherapy required
1-3 – may consider other clinical and diagnostic factors to exclude radiotherapy

Breast cancer
Breast cancer

Which criteria warrant post-operative radiotherapy if mastectomies are performed and lymph nodes are
negative?

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Positive margins, T4, luminal T3

T2 with high-risk features, high-grade tumors, triple negative, young age, lymphovascular invasion

Breast cancer
Breast cancer

What percentage of patients have internal mammary nodes that are positive if they have positive
axillary lymph nodes ?

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Up to 40% positive in triple negative patients

Breast cancer
Breast cancer

Should endocrine therapy be used concurrently or sequentially during radiotherapy?

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Used afterwards because side effect profile of aromatase inhibitor may lower radiotherapy compliance
and there is some contentious data about lowering radiotherapy efficacy

Breast cancer
Breast cancer

Should you give trastuzumab to patients with Her2 positive breast cancer concurrent with radiotherapy
or sequential?

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Concurrent is okay

Breast cancer
Breast cancer

Which lymph nodes are irradiated after neoadjuvant chemotherapy with patients who present with
positive lymph nodes?

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Infraclavicular, supraclavicular, internal mammary

Breast cancer
Breast cancer

Should neoadjuvant treated patients complete radiotherapy in the adjuvant setting ?

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Yes

Breast cancer
Breast cancer

What is the radiation field for lymph node positive breast cancer in the adjuvant setting ?

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Whole breast plus radiotherapy, boost to the tumor bed and radiotherapy to the axillary region

Breast cancer
Breast cancer

What portion of the chest is radiated during in breast cancer?

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Whole breast

Breast cancer
Breast cancer

What 2 categories of breast cancer can be excluded from radiotherapy ?

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Patients older than 65, hormone receptor positive negative, no lymph nodes, primary lesion less than 3
cm

Breast cancer
Breast cancer

Which prostate cancer treatment works in breast cancer ?

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enzalutamide

Breast cancer
Breast cancer

What fourth line endocrine treatment can be used for metastatic hormone receptor positive Her2 negative breast
cancer?

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enzalutamide

Breast cancer
Breast cancer

What endocrine treatment can be considered third line following progression on aromatase inhibitor,
CDK4/6, SERD, and mTOR?

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SERM

Breast cancer
Breast cancer

Is there an improvement in overall survival if exemestane is changed to anastrozole or letrozole in the
metastatic setting ?

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No

Breast cancer
Breast cancer

What was the French version of the BOLERO-2 clinical trial ?

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Everolimus plus tamoxifen (vs exemestane for BOLERO-2)

Breast cancer
Breast cancer

What did the MONARCH2 clinical trial show?

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Abemaciclib plus fulvestrant is superior to fulvestrant

Breast cancer
Breast cancer

What did the FACT and SWOG S0226 Clinical trials show?

View Answer
View Question

SERD + AI is superior to AI in the first-line setting for ER+Her2- IBC

Breast cancer
Breast cancer

What did the FALCON study compare?

View Answer
View Question

SERD vs AI in the first-line setting

Breast cancer
Breast cancer

What are the three CDK4/6 inhibitors that are available?

View Answer
View Question

Palbociclib
Ribociclib
Abemaciclib

Breast cancer
Breast cancer

What percentage of patients develop neutropenia with Palbociclib?

View Answer
View Question

80%

Breast cancer
Breast cancer

Which protein is downstream of CDK 4/6 ?

View Answer
View Question

retinoblastoma

Breast cancer
Breast cancer

What are some treatment first-line options in patients with ER+Her2- BC with no visceral crisis?

View Answer
View Question

CDK4/6 + AI or SERD
SERD + AI
CDK4/6 alone

Breast cancer
Breast cancer

How would you start first line treatment in a premenopausal women with hormone receptor positive Her2 negative stage IV
breast cancer?

View Answer
View Question

Ovarian suppression plus aromatase inhibitor plus CDK4/6 inhibitor

Breast cancer
Breast cancer

What is the difference between tamoxifen and raloxifene in the context of breast cancer treatment?

View Answer
View Question

Raloxifene is only used in the preventive setting

Breast cancer
Breast cancer

How long status post completion of endocrine treatment is it okay to rechallenge with the same agent?

View Answer
View Question

12 months

Breast cancer
Breast cancer

Which families of drugs added to aromatase inhibitors can improve overall survival?

View Answer
View Question

SERD, CDK4/6 and mTOR

Breast cancer
Breast cancer

How does chemotherapy plus endocrine therapy treatment improve overall survival?

View Answer
View Question

No change in overall survival with combination

Breast cancer
Breast cancer

What percentage of recurrent metastatic breast cancers have different hormone receptor and Her2 biology versus
primary disease?

View Answer
View Question

15%

Breast cancer
Breast cancer

Which adjuvant chemotherapy was used in the CREAT-X clinical trial ?

View Answer
View Question

capecitabine

It showed an improvement in five-year overall survival when added in the adjuvant setting following neoadjuvant taxane/anthracycline therapy versus adjuvant placebo

Breast cancer
Breast cancer

Following adjuvant treatment how long can radiotherapy be delayed prior to seeing adverse outcomes ?

View Answer
View Question

12 weeks

Breast cancer
Breast cancer

What regimen can one use for adjuvant treatment of low-risk endocrine receptor positive lymph node
negative breast cancer or triple-negative disease with negative lymph nodes with a primary that is
smaller than 1 cm and want to avoid an anthracycline?

View Answer
View Question

TC, if one wants to avoid Adriamycin

Breast cancer
Breast cancer

What is the primary side effect being mitigated when using steroids as premedication for taxanes?

View Answer
View Question

Hypersensitivity reactions as well as swelling

Breast cancer
Breast cancer

What premedications are required for taxanes ?

View Answer
View Question

Steroids

Breast cancer
Breast Cancer Part 5

What did the KATHERINE trial assess ?

View Answer
View Question

TDM-1 for residual Her2+ disease after neoadjuvant treatment with trastuzumab and a taxane

Breast Cancer Part 5
breast cancer

What did the MARIANNE trial assess for Her2+ metastatic breast cancer ?

View Answer
View Question

TDM-1 plus pertuzumab versus trastuzumab + docetaxel, showed similar efficacy (non-inferior but not superior) with less discontinuation

breast cancer
breast cancer

Does the addition of bevacizumab to docetaxel / trastuzumab in first line metastatic Her2+ breast cancer improve PFS ?

View Answer
View Question

No, AVEREL trial

breast cancer
breast cancer

Can vinorelbine be substituted for a taxane with trastuzumab in Her2+ metastatic breast cancer ?

View Answer
View Question

Yes, TRAVIOTA trial

breast cancer
breast cancer

What did the NALA trial assess ?

View Answer
View Question

Neratinib + capecitabine versus lapatinib + capecitabine in Her2+ metastatic breast cancer who had progressed on 2 lines of Her2 directed therapy

breast cancer
breast cancer

Was there a PFS that was statistically significant for trastuzumab emtansine from TH3RSEA ?

View Answer
View Question

Yes

breast cancer
breast cancer

What did the TH3RSEA trial assess ?

View Answer
View Question

The addition of trastuzumab emtansine to patients with metastatic Her2+ breast cancer who had progressed on trastuzumab, taxane and lapatinib

breast cancer
breast cancer

What is the most common grade 3/4 AE of Trastuzumab emtansine from the EMILIA trial ?

View Answer
View Question

Thrombocytopenia

breast cancer
breast cancer

What is the most common AE (all grades) of Trastuzumab emtansine from the EMILIA trial ?

View Answer
View Question

Nausea

breast cancer
breast cancer

What did the EMILIA trial assess ?

View Answer
View Question

Trastuzumab emtansine to Her2+ metastatic breast cancer after progression on trastuzumab and a taxane

breast cancer
breast cancer

What was the most common reported grade 3 / 4 AE with trastuzumab-deruxtecan in the DESTINY-Breast-01 trial ?

View Answer
View Question

Neutropenia

breast cancer
Breast cancer

What did the DESTINY-Breast-01 trial assess ?

View Answer
View Question

Addition of trastuzumab-deruxtecan in progressive Her2+ metastatic breast cancer who had progressed on trastuzumab emtansine

Breast cancer
breast cancer

What is the mechanism of deruxtecan ?

View Answer
View Question

TOPO-I inhibitor

breast cancer
Breast Cancer

Did patients with HR+ or HR- hormone receptor + status have better PFS in the CLEOPATRA trial ?

View Answer
View Question

HR negative, not a pre-planned subgroup

Breast Cancer
Breast Cancer

What did the CLEOPATRA trial assess ?

View Answer
View Question

Addition of pertuzumab to first-line trastuzumab plus docetaxel for Her2+ metastatic breast cancer

Breast Cancer
Breast Cancer

What was the most common adverse event in the BOLERO-1 trial (all grades) ?

View Answer
View Question

Stomatitis

Breast Cancer
Breast Cancer

From the BOLERO-1 trial, which patients have an improvement in PFS ?

View Answer
View Question

HR negative , though it barely missed the predetermined statistical significance, , p=0.0044 vs p=0.0049

Breast Cancer
Breast Cancer

What did the BOLERO-1 trial assess ?

View Answer
View Question

Addition of everolimus to paclitaxel and trastuzumab in first line metastatic setting

Breast Cancer
Breast Cancer

Were Her2+ patients included in the BOLERO-2 trial ?

View Answer
View Question

No

Breast Cancer
Breast Cancer

Was there a PFS improvement in the ALTERNATIVE trial ?

View Answer
View Question

Yes, statistically significant

Breast Cancer
Breast Cancer

What did the ALTERNATIVE trial assess ?

View Answer
View Question

Addition of lapatinib to first-line trastuzumab and anastrazole in HR+Her2+ metastatic breast cancer

Breast Cancer
Breast Cancer

Was an improvement in PFS seen in HR+Her2+ metastatic breast cancer from the TAnDEM trial ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What did the TAnDEM trial assess for HR+Her2+ metastatic breast cancer ?

View Answer
View Question

The addition of trastuzumab to anastrazole as first line treatment

Breast Cancer
Breast Cancer

Does the addition of bevacizumab to gemcitabine in HR+ Her2- metastatic breast cancer improve PFS ?

View Answer
View Question

Yes, TANIA and RIBBON-2 trials

Breast Cancer
Breast Cancer

What is the most common reported grade 3/4 AE reported in patients using capecitabine/lapatinib in advanced breast cancer ?

View Answer
View Question

Diarrhea (~20%)

Breast Cancer
Breast Cancer

Has eribulin shown an improvement in OS in heavily pretreated metastatic HR+ Her2- breast cancer patients ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What did the TANIA trial show for HR+Her2- metastatic breast cancer ?

View Answer
View Question

Continuation of bevacizumab from first line to second line setting in addition to chemotherapy improves PFS

Breast Cancer
Breast Cancer

What did the RIBBON-2 trial show for metastatic HR+ Her2- breast cancer ?

View Answer
View Question

PFS improvement with the addition of bevacizumab to nab-paclitaxel as second line treatment

Breast Cancer
Breast Cancer

What it he FAC regimen used in HR+Her2- breast cancer ?

View Answer
View Question

Fluorouracil (5-FU) 500 mg/m2 IV on day 1 Doxorubicin (Adriamycin) 40 mg/m2 IV on day 1 Cyclophosphamide (Cytoxan) 500 mg/m2 IV on day 1 on a 21 day cycle

Breast Cancer
Breast Cancer

What did the EMBRACE trial assess in breast cancer ?

View Answer
View Question

Eribulin in heavily pretreated metastatic breast cancer

Breast Cancer
Breast Cancer

What is the CMF regimen that has been used for adjuvant breast cancer ?

View Answer
View Question

Cyclophosphamide (Cytoxan) 600 mg/m2 IV on day 1, Methotrexate (MTX) 40 mg/m2 IV on day 1, Fluorouracil (5-FU) 600 mg/m2 IV on day 1 on a 21 day cycle

Breast Cancer
Breast Cancer

Does the addition of bevacizumab to nab-paclitaxel improve PFS in HR+Her2- metastatic breast cancer ?

View Answer
View Question

Yes, after first line single agent chemotherapy

Breast Cancer
Breast Cancer

Has nab-paclitaxel been shown to improve pCR rates in HR+Her2- breast cancer ?

View Answer
View Question

Yes, GeparSepto trial

Breast Cancer
Breast Cancer

Does the addition of bevacizumab improve pCR rates in HR+/Her2- breast cancer when given in the neoadjuvant setting ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What is the difference in dose for AC vs ddAC for adjuvant breast cancer management ?

View Answer
View Question

None, only a frequency difference of 1 week

Breast Cancer
Breast Cancer

Was an OS shown in the HER2CLIMB trial for tucatinib ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What was the most common AE seen with tucatinib in HER2CLIMB ?

View Answer
View Question

Diarrhea

Breast Cancer
Breast Cancer

Does Tucatinib have intracranial efficacy ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

Were brain mets allowed in the HER2CLIMB trial ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What did the HER2CLIMB trial assess in advanced breast cancer ?

View Answer
View Question

Tucatinib added to capecitabine/trastuzumab in patients with Her2+ advanced BC that had progressed on 1 or more Her2 containing regimens in a phase 3 trial

Breast Cancer
Breast Cancer Part 6

Breast Cancer Part 6

View Answer
View Question

Breast Cancer Part 6

Breast Cancer Part 6
Breast Cancer

Which doublet chemotherapy regimen added to trastuzumab in the advanced setting has been shown to improve overall survival?

View Answer
View Question

None – only improvements in PFS have been demonstrated

Breast Cancer
Breast Cancer

Has a statistically significant improvement in overall survival been seen with the addition of the lapatinib to capecitabine in patients with advanced HER-2/neu breast cancer?

View Answer
View Question

No only a trend

Breast Cancer
Breast Cancer

How common is grade 3 or higher diarrhea with a combination of neratinib and capecitabine for advanced HER-2/neu breast cancer?

View Answer
View Question

24% per the NALA trial

Breast Cancer
Breast Cancer

What dose of capecitabine is recommended when combined with lapatinib for advanced HER-2/neu breast cancer?

View Answer
View Question

1

Breast Cancer
Breast Cancer

What were the 2 treatment arms in the NALA trial for HER-2/neu advanced breast cancer?

View Answer
View Question

Neratinib plus capecitabine versus capecitabine

Breast Cancer
Breast Cancer

How many lines of therapy were patients exposed to in the NALA trial ?

View Answer
View Question

Two or more

Breast Cancer
Breast Cancer

Which clinical trial established the efficacy of margetuximab for advanced HER-2/neu breast cancer?

View Answer
View Question

SOPHIA trial

Breast Cancer
Breast Cancer

How common is left ventricular dysfunction with margetuximab ?

View Answer
View Question

2%

Breast Cancer
Breast Cancer

What are the most common grade 3 or 4 adverse events with tucatinib + capecitabine + trastuzumab ?

View Answer
View Question

Palmar plantar erythema and diarrhea

Breast Cancer
Breast Cancer

How common is grade 3/4 neutropenia with trastuzumab deruxtecan ?

View Answer
View Question

21%

Breast Cancer
Breast Cancer

Which agent was TDM -1 compared to in the EMILIA trial ?

View Answer
View Question

Lapatinib plus capecitabine

Breast Cancer
Breast Cancer

Which agents were patients required to be exposed to in the EMILIA trial ?

View Answer
View Question

Trastuzumab plus a taxane

Breast Cancer
Breast Cancer

What is the recommended first-line treatment in PD-L1 negative non-BRCA mutated metastatic triple negative breast cancer?

View Answer
View Question

Chemotherapy

Breast Cancer
Breast Cancer

Is a platinum agent preferred for PD-L1 negative/BRCA negative advanced triple negative breast cancer?

View Answer
View Question

No

Breast Cancer
Breast Cancer

Which adverse event is significantly higher with platinum agents for advanced triple negative breast cancer?

View Answer
View Question

Nausea and vomiting

Breast Cancer
Breast Cancer

Which immunotherapy agents are most commonly utilized in advanced triple negative breast cancer which are PD-L1 positive?

View Answer
View Question

Pembrolizumab and atezolizumab

Breast Cancer
Breast Cancer

Which biomarker predicts for a statistically significant improvement in overall survival with atezolizumab for–triple negative breast cancer?

View Answer
View Question

PD-L1 expression on immune effector cells

Breast Cancer
Breast Cancer

Which clinical trial showed an improvement in progression free survival and overall survival with atezolizumab for triple negative metastatic breast cancer?

View Answer
View Question

IMpassion 130

Breast Cancer
Breast Cancer

Which clinical trial showed the efficacy of pembrolizumab in advanced triple negative breast cancer?

View Answer
View Question

KEYNOTE 355

Breast Cancer
Breast Cancer

Can a PD-L1 targeting antibody be used as first-line treatment in patients with a germline BRCA mutation in advanced triple negative breast cancer?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

Does prior chemotherapy predict for an improved response to PARP inhibitors in advanced triple negative breast cancer?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What is the biological target of sacituzumab govitecan ?

View Answer
View Question

Trop-2

Breast Cancer
Breast Cancer

What is the alternative drug name for govitecan -the payload for sacituzumab ?

View Answer
View Question

SN-38 -active metabolite of irinotecan

Breast Cancer
Breast Cancer

Has an improvement in overall survival been demonstrated with sacituzumab govitecan ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer Part 6

Breast Cancer Part 6

View Answer
View Question

Breast Cancer Part 6

Breast Cancer Part 6
Breast Cancer Part 6

Is there data supporting the superiority of cisplatin in neoadjuvant cisplatin in triple negative breast cancer to AC ?  

View Answer
View Question

No

Breast Cancer Part 6
Breast Cancer Part 6

What it another name for govitecan ?

View Answer
View Question

SN-38, active metabolite of irinotecan

Breast Cancer Part 6
Breast Cancer

What is the intracellular target of Sacituzumab’s payload ?

View Answer
View Question

Topo – I

Breast Cancer
Breast Cancer

What is the cell surface target of Sacituzumab ?

View Answer
View Question

Trop-2

Breast Cancer
Breast Cancer

What it the payload in Sacituzumab ?

View Answer
View Question

Govitecan

Breast Cancer
Breast Cancer

Was a survival advantage demonstrated with the use of capecitabine in the adjuvant setting for triple negative breast cancer in the CBCSG010 trial ?

View Answer
View Question

No

Breast Cancer
Breast Cancer

What was the purpose of the CBCSG010 clinical trial in breast cancer?

View Answer
View Question

Determine the utility of capecitabine in the adjuvant setting for triple negative breast cancer

Breast Cancer
Breast Cancer Demo

Does the addition of ixabepilone to capecitabine after progression on a taxane and anthracycline improve PFS in triple negative breast cancer ?

View Answer
View Question

Yes

Breast Cancer Demo
Breast Cancer Demo

Can palbociclib be used in men with breast cancer ?

View Answer
View Question

Yes

Breast Cancer Demo
Breast Cancer Demo

What was the most common reported grade 3 / 4 AE with trastuzumab-deruxtecan in the DESTINY-Breast-01 trial ?

View Answer
View Question

Neutropenia

Breast Cancer Demo
Breast Cancer Demo

What did the TRINITI-1 trial assess for HR+ Her2- breast cancer ?

View Answer
View Question

Everolimus + ribociclib + exemestane in patients that had progressed on CDK4/6 + AI with 1 year PFS 33% , ASCO 2019 #1016

Breast Cancer Demo
Breast Cancer

What did the TRINITI-1 trial assess for HR+ Her2- breast cancer ?

View Answer
View Question

Everolimus + ribociclib + exemestane in patients that had progressed on CDK4/6 + AI with 1 year PFS 33% , ASCO 2019 #1016

Breast Cancer
Breast Cancer

Can palbociclib be used in men with breast cancer ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

Is there data to support the use of abemaciclib after progression on palbociclib in advanced breast cancer ?

View Answer
View Question

Yes, ASCO 2019 abstract 1057

Breast Cancer
Breast Cancer

What did the CONFIRM trial assess in HR+ Her2- metastatic breast cancer ?

View Answer
View Question

Superiority wrt PFS of Fulvestrant 500mg versus 250mg

Breast Cancer
Breast Cancer

Was arthlargia more common with fulvestrant or anastrazole in the FLACON rial in advanced breast cancer ?

View Answer
View Question

Fulvestrant

Breast Cancer
Breast Cancer

What did the FALCON trial show in advanced breast cancer ?

View Answer
View Question

Improvement in PFS with fulvestrant as first line treatment in HR+ Her2- metastatic breast cancer

Breast Cancer
Breast Cancer

What was the most common grade 3/4 AE with the MONALEESA-7 trial in advanced breast cancer ?

View Answer
View Question

Neutropenia, seen in 60%

Breast Cancer
Breast Cancer

What did the MONALEESA-3 trial assess ?

View Answer
View Question

Ribociclib in addition to fulvestrant for postmenopausal women with HR+ metastatic breast cancer as first or second-line treatment

Breast Cancer
Breast Cancer

What is the standard dosing of ribociclib ?

View Answer
View Question

600mg daily

Breast Cancer
Breast Cancer

What was the endocrine treatment used in the MONALEESA-7 trial ?

View Answer
View Question

Goserelin + Anastrazole

Breast Cancer
Breast Cancer

Did the MONALEESA – 7 trial include pre-menopausal women ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

What did the MONALEESA-7 trial assess ?

View Answer
View Question

Ribociclib in addition to endocrine therapy for premenopausal women with HR+ metastatic breast cancer as first line treatment

Breast Cancer
Breast Cancer

What did the SWOG S0226 trial assess ?

View Answer
View Question

Anastrazole and Fulvestrant in combination as first line treatment in HR+Her2- metastatic breast cancer

Breast Cancer
Breast Cancer

What did the FACT trial assess ?

View Answer
View Question

Anastrazole and Fulvestrant in combination as first line treatment in HR+Her2- metastatic breast cancer

Breast Cancer
Breast Cancer

Which agents were used in MONARCH – 3 ?

View Answer
View Question

Abemaciclib and Anastrazole/Letrozole

Breast Cancer
Breast Cancer

Was the MONARCH -3 trial randomized ?

View Answer
View Question

Yes

Breast Cancer
Breast Cancer

Is there a statistically significant advantage to adding bevacizumab to standard adjuvant chemo after surgery in triple negative breast cancer ?

View Answer
View Question

No

Breast Cancer
Breast Cancer

What did the BEATRICE trial evaluate in triple negative breast cancer ?

View Answer
View Question

Addition of bevacizumab to standard adjuvant chemo after primary surgery

Breast Cancer
Breast Cancer

Is there randomized data to support the use of gemcitabine+ cisplatin in the first line setting for triple negative breast cancer ?

View Answer
View Question

Yes, Chinese CBCSG006 trial

Breast Cancer
Breast Cancer

Is the regimen from IMPassion a 21 or 28 day cycle ?

View Answer
View Question

28-day cycle, paclitaxel 1,8,15 and Atezo 1,15

Breast Cancer
Breast Cancer

Is PDL-1 status a predictive marker for response to atezolizumab + nab-paclitaxel in triple negative breast cancer ?

View Answer
View Question

Yes, statistically significant from the IMPassion trial

Breast Cancer
Breast Cancer

What was the most common grade 3/4 AE with atezolizumab + nab-paclitaxel in the IMPassion trial ?

View Answer
View Question

Neutropenia

Breast Cancer
Breast Cancer

What was the ORR for the IMPassion trial for atezolizumab + nab-paclitaxel ?

View Answer
View Question

58%

Breast Cancer
Breast Cancer

What did the IMPassion -30 trial assess ?

View Answer
View Question

Addition of atezolizumab to nab-paclitaxel versus nab-pacliatxel in the first line setting for metastatic triple negative breast cancer

Breast Cancer
Breast Cancer

Does the addition of ixabepilone to capecitabine after progression on a taxane and anthracycline improve PFS in triple negative breast cancer ?

View Answer
View Question

Yes

Breast Cancer
breast cancer

What is E in the FEC regimen for breast cancer ?

View Answer
View Question

Epirubicin

breast cancer
breast cancer

What did the APHINITY trial assess ?

View Answer
View Question

Addition of pertuzumab to 1 year of trastuzumab and standard adjuvant chemo in node positive and high risk Her2 positive operable breast cancer

breast cancer
breast cancer

Does a PIK3CA nutation predict for inferior PFS for HR+Her2- metastatic breast cancer patients on fulvestrant + palbociclib ?

View Answer
View Question

No, ASCO 2019 abstract 1010

breast cancer
breast cancer

Does the addition of pembrolizumab to eribulin improve PFS in HR+Her2- metastatic breast cancer who had progressed on endocrine therapy and chemotherapy ?

View Answer
View Question

No

breast cancer
breast cancer

What did the PERSEPHONE trial asses in Her2+ breast cancer ?

View Answer
View Question

6mo adjuvant trastuzumab is non-inferior to 12mo adjuvant trastuzumab in early Her2+ breast cancer

breast cancer
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