Locally Advanced and Metastatic Breast Cancer

1. 64-year-old woman is evaluated for recurrent breast cancer with bone and liver metastases. She
was diagnosed with stage IA estrogen receptor–positive, progesterone receptor–positive, HER2-
negative right breast cancer 10 years ago. She underwent lumpectomy and sentinel lymph-node
biopsy and primary breast radiation, and completed 5 years of anastrozole 2 years ago. She
presented with right hip pain, with lesions on a bone scan consistent with metastases. Biopsy of
a bone lesion shows metastatic carcinoma that is ER- positive, PR-positive, and HER2-negative,
consistent with metastatic breast cancer. On PE, tenderness to palpation of the right lateral hip
is noted, while the remainder of the examination is normal. Which of the ff is the most
appropriate treatment?
A. Exemestane
B. Letrozole + Palbociclib
C. Raloxifene
D. Tamoxifen

2. A 46-year-old female, previously treated for Breast Cancer Stage II, presents with jaundice. On
work-up, a suspicious liver mass was noted on Whole Abdominal CT scan. What is the most
appropriate next step?
A. Initiation of combination chemotherapy with a platinum-based agent and a taxane
B. Radiation to the possible site of metastasis
C. Biopsy of the suspicious liver lesion
D. Mastectomy followed by endocrine therapy

3. For patients with metastatic breast cancer, in which situations are combination chemotherapy
regimens preferred over single-agent chemotherapy?
A. When the patient has prior exposure to multiple neoadjuvant and adjuvant systemic agents
B. In the presence of severe, disease-related symptoms that require rapid tumor shrinkage
C. When the patient is desirous of a longer life, despite of risk for treatment-related toxicity
D. Patients with multiple, asymptomatic metastatic sites of disease

4. This has been approved as first line therapy for recurrent unresectable TNBC and metastatic
TNBC:
A. Pembrolizumab + Chemotherapy
B. Sacituzumab govitecan
C. Trastuzumab deruxtecan
D. Neratinib
5. What is primary endocrine resistance?
A. Relapse during the first 2 years of adjuvant endocrine therapy
B. Relapse during the first year of adjuvant endocrine therapy
C. Relapse within 12 months of completing adjuvant endocrine therapy
D. Disease progression 6 months after initiating endocrine therapy in metastatic breast cancer

6. A 54-year-old postmenopausal woman presents with breast cancer that is ER-positive, PR-
negative, and HER2-positive, with metastasis to the bone, lung, and axillary LN. The patient was
given docetaxel and trastuzumab, with treatment response in all sites of the disease. After 8
 months of therapy, the patient complained of worsening back pain. Imaging revealed
progression of disease in the lungs and bones. What is the best option for the next line of
treatment for this patient?
A. Capecitabine + Lapatinib
B. Tamoxifen
C. Ado-trastuzumab emtansine
D. Add Pertuzumab to the current regimen
7. A 50-year-old postmenopausal woman is diagnosed with ER-positive, PR-positive, and HER2-
positive invasive ductal carcinoma. Multiple liver masses were noted on CT scan, for which a
biopsy was done, proving metastasis. An echocardiogram reveals normal LVEF of 63%, with no
significant cardiac findings. Aside from the left breast mass, the patient only complains of
generalized fatigue. What is the best management for the patient?
A. Palliative chemotherapy with docetaxel, carboplatin, and trastuzumab every 3 weeks
B. Cranial MRI to rule out intracranial metastasis
C. Endocrine therapy with aromatase inhibitor + Palbociclib
D. Palliative chemotherapy with docetaxel, trastuzumab, and pertuzumab every 3 weeks
8. A 38-year-old female was diagnosed with triple-negative inflammatory breast cancer, initially
presenting with left breath erythema and edema. Work up for distant metastasis was negative.
What is the next best step in managing the patient?
A. Refer to Radiation Oncology for radiotherapy
B. Breast conserving surgery
C. Total mastectomy with axillary lymph node dissection, followed by breast reconstruction
surgery and adjuvant chemotherapy with a taxane-based regimen
D. Neoadjuvant chemotherapy with an anthracycline-based regimen
9. A 32-year-old female presented with a 6.5 cm right breast mass and right mid-axillary
lymphadenopathy. Biopsy revealed invasive ductal carcinoma. The patient denies headache,
abdominal pain, bone pains, dyspnea, and claims that she feels generally well. What is the next
best step in managing the patient?
A. Chest and Whole Abdomen CT scans with contrast, Bone Scan
B. Initiate chemotherapy with Paclitaxel
C. Since the patient is asymptomatic, there is no indication to do imaging for distant metastasis
D. Refer to Surgery for Modified Radical Mastectomy
10. A 55-year-old female was diagnosed with Triple-Negative Breast Cancer Stage IIIB, for which she
was able to complete neoadjuvant chemotherapy with dose-dense AC followed by paclitaxel. On
restaging, patient was noted to have 2 enlarged right axillary lymph nodes, measuring 0.5-1 cm.
There was no evidence of distant metastasis. What is the next best step?
A. Start Olaparib
B. Start Capecitabine
C. Start Ado-trastuzumab emtasine
D. Start Paclitaxel + Carboplatin

Answer Key:
1) B
2) C
3) B
4) A
5) A
6) C
7) D
8) D
9) A
10) B