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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A patient with cT2N1 triple-negative breast cancer receives neoadjuvant pembrolizumab with platinum-taxane followed by anthracycline-cyclophosphamide and has a pathological complete response at surgery. What is the NICE-aligned postoperative systemic plan?

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Correct answer: C — Continue adjuvant pembrolizumab to complete the peri-operative course despite pathological complete response

NICE TA851 describes a peri-operative regimen: pembrolizumab is combined with neoadjuvant chemotherapy and then continued alone after surgery. The recommendation is based on high-risk early or locally advanced TNBC and is not restricted by PD-L1 status or withdrawn solely because a pathological complete response occurs. Capecitabine is considered for residual disease rather than routine use after pCR, and atezolizumab is not substituted postoperatively.

Reference: NICE TA851 pembrolizumab for neoadjuvant and adjuvant treatment of triple-negative breast cancer (Published December 2022): https://www.nice.org.uk/guidance/ta851/chapter/1-Recommendations