MSCO | QNA

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Q1. According to international treatment guidelines, which HER2-positive early breast cancer (eBC) patients should preferably go for neoadjuvant treatment?

A: N+ only 0%

B: Tumour ≥ 2 cm only 0%

C: N+ and/or tumour ≥ 2 cm 0%

D: N+ and tumour ≥ 2 cm 0%

International guidelines including NCCN and ESMO recommend neoadjuvant therapy for HER2-positive eBC patients with T≥ 2 and / or N ≥ 1.

Ref: 1) NCCN Breast Cancer Guidelines v4.2020; 2) Early Breast Cancer: ESMO Clinical Practice Guidelines. Ann Oncol (2019); 30: 1194-1220.

Q2. For neoadjuvant patients, pre-treatment marking is essential if breast and axillary surgery are to e altered following treatment, because:

A: Many patients patients will have a complete radiological response (CRR) 0%

B: Axillary clips improve the false-negative rate of post-neoadjuvant axillary staging 0%

C: Even if mastectomy is mandated or planned, marking the original disease facilitates pathological assessment after surgery 0%

D: All of the above 0%

E: None of the above 0%

All of the above and according to Caudle AS, et al, it was found that targeted axillary dissection (TAD) could improve the accuracy of axillary staging in clinically node-positive patients who received neoadjuvant therapy.

Ref: Caudle AS, et al. J Clin Oncol. 2016 Apr 1;34(10):1072-8

Q3. Which breast cancer subtypes has the highest likelihood of achieving pathological complete response (pCR) after neoadjuvant treatment?

A: Triple negative 0%

B: HER2-positive, HR-negative 0%

C: HER2-positive, HR-positive 0%

D: HER2-negative, HR-positive 0%

As reported in the CTNeoBC pooled analysis, HER2-positive, HR-negative subtype has the highest pCR rate (50.3% with trastuzumab).

Ref: Cortazar P, et al. Lancet. 2014 Jul 12;384(9938):164-72.

Q4. Which breast cancer subtypes has the lowest likelihood of achieving pathological complete response (pCR) after neoadjuvant treatment?

A: Triple negative 0%

B: HER2-positive, HR-negative 0%

C: HER2-positive, HR-positive 0%

D: HER2-negative, HR-positive 0%

As reported in the CTNeoBC pooled analysis, HER2-negative, HR-positive subtype has the lowest pCR rate (7.5% for grade 1/2, and 16.2% for grade 3).

Ref: Cortazar P, et al. Lancet. 2014 Jul 12;384(9938):164-72.

Q5. For HER2-positive eBC patients who have residual invasive disease after neoadjuvant therapy, which of the following is the recommended treatment regimen according to international guidelines?

A: Pertuzumab + trastuzumab to complete 18 cycles 0%

B: Trastuzumab to complete 18 cycles 0%

C: T-DM1 for 14 cycles 0%

D: None of the above 0%

International guidelines including NCCN, ESMO, AGO, and St. Gallen all recommend T-DM1 for patients with residual invasive disease after neoadjuvant therapy.

Ref: 1) NCCN Breast Cancer Guidelines v4.2020; 2) Early Breast Cancer: ESMO Clinical Practice Guidelines. Ann Oncol (2019); 30: 1194-1220.; 3) AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2019. Breast Care 2019;14:224–245.; 4) Primary Therapy of Early Breast Cancer: Evidence, Controversies, Consensus - Spectrum of Opinion of German Specialists on the 16th St. Gallen International Breast Cancer Conference. Geburtshilfe Frauenheilkd. 2019 Jun; 79(6): 591–604.