Breast Cancer

Incorporation of gemcitabine into adjuvant anthracyclines- and taxanes-based chemotherapy does not improve efficacy.

Question 24.21 The answer is A.

Preexisting cardiac disease, age >65 years, anthracycline-based chemotherapy, borderline left ventricular ejection fraction, and hypertension are all risk factors for cardiac dysfunction with adjuvant trastuzumab.

Question 24.22 The answer is C.

Complete blood counts and liver function tests, cancer antigen 15-3, and yearly computed tomography scans are not indicated in routine surveillance for early stage breast cancer patients.

Question 24.23 The answer is D.

All patients presenting with clinical features of IBC should undergo full-staging work up due to the substantial risk of metastatic disease. Involvement of dermal lymphatics in the absence of clinical findings does not indicate IBC as it is a clinical diagnosis. Due to the high risk of local recurrence, all patients with IBC should undergo postmastectomy radiation regardless of the response to neoadjuvant therapy.

Question 24.24 The answer is D.

Male breast cancer is found, more often than female breast cancer, to be estrogen-receptor positive. Chronic liver disorders, Klinefelter syndrome (XXY), BRCA 1 or 2 mutations, mumps orchitis, undescended testis, testicular injury, and feminization are all associated with an increased risk of male breast cancer. The median age of onset is later than in females. The same considerations regarding nodal surgery pertain for men as for women.

Question 24.25 The answer is B.

The optimal duration of intravenous bisphosphonates or RANK-ligand inhibitors is not well characterized. Intravenous bisphosphonates and RANK-ligand inhibitors lessen the pain associated with bone metastases and prevent skeletal-related complications, such as hypercalcemia and fractures. Bone-directed therapies in patients with widespread bone metastases do not impact overall survival.

Corresponding chapters in Cancer: Principles & Practice of Oncology, Tenth Edition: 78 (Molecular Biology of Breast Cancer), 79 (Malignant Tumors of the Breast), and 80 (Genetic Testing in Breast Cancer).

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