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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

After neoadjuvant taxane chemotherapy with trastuzumab-pertuzumab, surgery shows residual invasive HER2-positive carcinoma in breast and axillary nodes. Which postoperative HER2-directed treatment is indicated?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Trastuzumab emtansine for fourteen cycles

Explanation lettering: C = shown as A · A = shown as C · E = shown as D · D = shown as E

C is correct. NICE TA632 recommends trastuzumab emtansine after neoadjuvant taxane-based and HER2-targeted treatment when residual invasive disease remains in breast or lymph nodes. The standard KATHERINE schedule is 14 cycles, subject to toxicity and recurrence. Lapatinib-capecitabine is not routine in this setting, neratinib is not a substitute for T-DM1, and continuing trastuzumab with or without pertuzumab misses the evidence-based escalation for residual disease. Confirming residual HER2 status can inform discussion, but loss of staining after treatment does not automatically negate the trial-defined strategy.

Reference: NICE TA632 adjuvant trastuzumab emtansine recommendations: https://www.nice.org.uk/guidance/ta632/chapter/1-Recommendations