American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for patients desiring breast-conserving surgery with HER2-amplified or triple-negative breast cancers?

1. Radiation therapy

2. Neoadjuvant chemotherapy trastuzumab-based

3. Adjuvant chemotherapy

4. Hormonal therapy

The correct answer is: Neoadjuvant chemotherapy trastuzumab-based

The recommended treatment for patients desiring breast-conserving surgery with HER2-amplified or triple-negative breast cancers is neoadjuvant chemotherapy, specifically trastuzumab-based therapy for HER2-positive tumors. Neoadjuvant chemotherapy serves several purposes in the management of these aggressive breast cancer subtypes. For HER2-amplified breast cancer, the combination of chemotherapy with targeted therapy, such as trastuzumab, enhances the effectiveness of treatment, allowing for better tumor response rates and reducing the likelihood of residual cancer following surgery. Additionally, it can reduce the size of the tumor, making surgery more feasible and allowing for breast-conserving options when they might not be possible otherwise. For triple-negative breast cancer, which is characterized by the absence of HER2 expression as well as hormonal receptor positivity, neoadjuvant chemotherapy is similarly effective. This approach helps to shrink the tumor, potentially allowing for less extensive surgical intervention and improving overall survival rates. This preoperative strategy has become an important standard in the management of these cancer subtypes, as it has been shown to improve surgical outcomes and achieve pathological complete response, which is associated with better long-term prognosis.