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Breast Cancer – Metastatic Disease

Question 20

Which clinical scenario requires urgent multidisciplinary discussion in metastatic breast cancer management?

A.Pleural effusion if patient is symptomatic

B.Stable lung metastasis

C.Uncomplicated bone metastasis

D.No evidence of disease

Question 1

What is the primary purpose of performing a biopsy in the evaluation for metastatic breast cancer?

A.To confirm metastatic disease and determine histology, ER/PR, and HER2 status

B.To determine if the patient needs surgery

C.To assess bone mineral density

D.To evaluate renal function

Question 2

Which combination is preferred as first-line therapy for postmenopausal HR-positive/HER2-negative metastatic breast cancer?

A.Tamoxifen plus chemotherapy

B.Aromatase inhibitor (AI) or fulvestrant with ribociclib or abemaciclib

C.Trastuzumab and lapatinib

D.Capecitabine with paclitaxel

Question 3

What is the recommended treatment for patients with HER2-positive metastatic breast cancer and no prior trastuzumab exposure?

A.Docetaxel or paclitaxel plus trastuzumab and pertuzumab

B.Endocrine therapy alone

C.Aromatase inhibitor plus lapatinib

D.Tamoxifen alone

Question 4

For HR-negative/HER2-negative (triple negative) metastatic breast cancer with PD-L1 expression, which therapy is preferred?

A.Aromatase inhibitor monotherapy

B.Trastuzumab plus chemotherapy

C.Pembrolizumab plus chemotherapy

D.Tamoxifen

Question 5

Which patients should be considered for genetic testing?

A.Only those with a family history

B.All patients with metastatic breast cancer, regardless of subtype and family history

C.Only patients under 40 years old

D.Only those with HER2-positive disease

Question 6

What performance status score indicates a patient is fully active, able to carry on all pre-disease performance without restriction according to the ECOG scale?

A.2

B.3

C.1

D.0

Question 7

What is the next recommended therapy for HR-positive/HER2-negative metastatic breast cancer if a patient progresses after AI and CDK4/6 therapy and has a PIK3CA mutation?

A.Fulvestrant with alpelisib or capivasertib

B.Tamoxifen only

C.Docetaxel and trastuzumab

D.Pembrolizumab

Question 8

For bone metastases in metastatic breast cancer patients with life expectancy >12 weeks and creatinine clearance ≥ 30 mL/min, what should be administered?

A.Tamoxifen

B.Bisphosphonate or denosumab after dental evaluation

C.Only chemotherapy

D.No additional therapy

Question 9

In patients with oligometastatic breast cancer and excellent response to systemic therapy, what treatment may be considered?

A.Locoregional therapy (surgery/radiation) in a multidisciplinary setting

B.Palliative mastectomy for all patients

C.Immediate discontinuation of systemic therapy

D.No further intervention

Question 10

Which therapy is used for HR-positive, HER2-low tumors after one line of systemic chemotherapy in the metastatic setting?

A.Fam-trastuzumab deruxtecan-nxki

B.Vinorelbine

C.Fulvestrant with alpelisib

D.Capecitabine and lapatinib

Question 11

What should be done if substantial bone lesions are present in weight-bearing areas not included in initial CT scans of metastatic breast cancer patients?

A.Repeat PET/CT for the entire body

B.Obtain additional views to rule out impending fractures

C.No further imaging is needed

D.Proceed with endocrine therapy

Question 12

Which chemotherapy combination is a preferred regimen for HER2-positive disease in patients naïve to trastuzumab or recurring >6 months after adjuvant trastuzumab?

A.Trastuzumab with paclitaxel alone

B.Pertuzumab plus trastuzumab plus paclitaxel or docetaxel

C.Gemcitabine and carboplatin

D.Tamoxifen plus everolimus

Question 13

What is considered a clinical scenario requiring individualized therapy in metastatic breast cancer?

A.Oligometastasis or Stage IV NED

B.Single site bone metastasis only

C.Stable primary tumor with no metastasis

D.Any case of localized breast cancer

Question 14

Which agent should be added if a triple negative metastatic breast cancer patient has a germline BRCA mutation?

A.Palbociclib

B.Talazoparib or olaparib

C.Trastuzumab emtansine

D.Letrozole

Question 15

What is the function of the Multidisciplinary Team discussion in metastatic breast cancer care?

A.To plan patient imaging appointments

B.To determine appropriate sequencing of treatment options

C.To prescribe hormone therapy only

D.To perform surgery

Question 16

How should patients with progressive disease and ECOG performance status of 3 or higher generally be managed?

A.Aggressive multi-agent chemotherapy

B.Supportive care alone

C.Immediate surgery

D.Continue current systemic therapy regardless

Question 17

Which agent is appropriate for HR-positive/HER2-negative metastatic breast cancer with an ESR1 mutation?

A.Elacestrant

B.Capecitabine

C.Denosumab

D.Paclitaxel

Question 18

For patients with HER2-positive, HR-negative metastatic breast cancer and prior trastuzumab exposure, what is a second-line therapy option?

A.Tamoxifen

B.Fam-trastuzumab deruxtecan-nxki

C.Docetaxel and paclitaxel

D.Letrozole

Question 19

What is the preferred approach for maintenance of response in HR-positive/HER2-positive metastatic breast cancer when toxicity prompts discontinuation of anti-HER2 therapy?

A.Endocrine therapy may be used for maintenance of response

B.Discontinue all treatment

C.Switch to triple chemotherapy

D.Use bisphosphonate only