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Breast Cancer — SCE Medical Oncology MCQ

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EasyBreast CancerBreast CancerSCE Medical Oncology

A 62-year‑old woman presents to the breast cancer MDT with a newly diagnosed 35 mm grade 3 invasive ductal carcinoma. Immunohistochemistry shows ER 0%, PR 0%, HER2 IHC 3+. CT staging reveals multiple liver metastases. ECOG PS 0. What is the most appropriate first‑line systemic therapy?

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Correct answer: C — Docetaxel + trastuzumab + pertuzumab

Explanation lettering: B = shown as A · D = shown as B · A = shown as D

The correct answer is C. In the UK, for untreated HER2‑positive metastatic breast cancer, first‑line standard of care is dual HER2 blockade with pertuzumab and trastuzumab plus a taxane (typically docetaxel), as established by the CLEOPATRA trial and recommended by NICE TA424. NICE TA862 reaffirms this current NHS standard for first‑line therapy. Option B (trastuzumab deruxtecan) is only licensed after prior anti‑HER2 therapy and currently available via managed access, not first‑line. Option D (T‑DM1) is second‑line post‑trastuzumab/taxane. Options A and E lack dual HER2 blockade or are inferior regimens.

Reference: NICE TA424 (pertuzumab plus trastuzumab and docetaxel for HER2‑positive breast cancer), NICE TA862 committee discussion confirming standard first‑line regimen, 2023/2016; NICE guidance.