TEOC Oncologia Clínica Practice Questions - TEOC - Título De Especialista Em Oncologia Clínica (Sociedade Brasileira De Oncologia Clínica AMB) Exam

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A 42-year-old premenopausal woman presents with a palpable 3.2 cm mass in the upper outer quadrant of the right breast. Core needle biopsy confirms invasive ductal carcinoma, histological grade 3, estrogen receptor (ER) 0%, progesterone receptor (PR) 0%, and HER2 immunohistochemistry 0 (triple-negative breast cancer). Right axillary ultrasound-guided fine needle aspiration reveals metastatic carcinoma in one lymph node (cT2 cN1 cM0, Stage IIB). Based on the landmark KEYNOTE-522 trial and SBOC guidelines, what is the standard neoadjuvant systemic therapy regimen for this patient?

Dose-dense AC (doxorubicin and cyclophosphamide) followed by paclitaxel alone for 8 cycles without immunotherapy. Neoadjuvant pembrolizumab combined with carboplatin and paclitaxel, followed by pembrolizumab with doxorubicin (or epirubicin) and cyclophosphamide, followed after definitive surgery by adjuvant pembrolizumab to complete 1 year. Neoadjuvant carboplatin and paclitaxel followed by surgery, reserving pembrolizumab exclusively for the adjuvant setting in case of residual disease. Neoadjuvant chemotherapy with docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) followed by adjuvant T-DM1.

Correct Answer:

Neoadjuvant pembrolizumab combined with carboplatin and paclitaxel, followed by pembrolizumab with doxorubicin (or epirubicin) and cyclophosphamide, followed after definitive surgery by adjuvant pembrolizumab to complete 1 year.

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