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MSCC Breast Cancer — SCE Medical Oncology MCQ

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ModerateBreast CancerMSCC Breast CancerSCE Medical Oncology

A 68-year-old woman with ER+/HER2- metastatic breast cancer and widespread bone metastases develops acute bilateral leg weakness. Emergency MRI whole spine shows metastatic spinal cord compression at T6. She also has known brain metastases. In the context of breast cancer specifically, what additional systemic treatment consideration is important?

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Correct answer: C — Breast cancer MSCC may respond to urgent endocrine therapy or chemotherapy in addition to emergency steroids and RT/surgery — effective systemic therapy can contribute to decompression

While dexamethasone and emergency local treatment (surgery/radiotherapy) are the immediate priorities for MSCC, initiating or optimising systemic oncological therapy (endocrine therapy, chemotherapy, CDK4/6 inhibitors) is also important in breast cancer MSCC. Unlike some cancers, breast cancer often responds well to systemic therapy, which can contribute to tumour shrinkage and prevent further cord compromise. This is complementary to (not a substitute for) emergency decompressive treatment.

Reference: NICE CG75 MSCC; ESMO 2024 Breast Cancer; ESMO Oncological Emergencies