1. Which of the following is TRUE regarding triple-negative breast cancer (TNBC)?
A. TNBC accounts for over 50% of all breast cancer cases
B. TNBC is more aggressive, has a higher rate of recurrence, and is associated with worse outcomes than other breast cancer subtypes
C. TNBC is more commonly found in older white women than in other age and ethnic groups
D. TNBC rarely metastasizes to the lungs or brain
E. Unsure
2. For questions 2 and 3, please use the following patient CASE:
MM is a 49-year-old female diagnosed with a right-sided 6-cm triple-negative breast cancer (TNBC) (cT3 N0 M0). She received neoadjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide followed by weekly paclitaxel and carboplatin for 12 weeks. She had a mastectomy and did not achieve a pathologic complete response (i.e., residual disease remained).
Based on data from the Create-X trial, what adjuvant treatment should be offered to MM?
A. Talazoparib
B. Capecitabine
C. Pembrolizumab
D. Atezolizumab + nab-paclitaxel
E. Unsure
3. MM subsequently completed 6 cycles of adjuvant capecitabine. She has recently been diagnosed with biopsy-proven metastatic TNBC (mTNBC), which is BRCA-negative and has a PD-L1 >1%.
A. Olaparib
B. Pembrolizumab
C. Atezolizumab + nab-paclitaxel
D. Carboplatin
E. Unsure
4. CC is a 37-year-old female with ER/PR(–), HER2(–), BRCA-mutated breast cancer. She is initiating olaparib therapy. What are the most important adverse events about which to counsel CC prior to initiating this treatment?
A. Fatigue, nausea, hand-foot syndrome, and myelosuppression
B. Fatigue, nausea, diarrhea, and myelosuppression
C. Fatigue, constipation, myelosuppression, and peripheral neuropathy
D. Nausea, diarrhea, hyperglycemia, and peripheral neuropathy
E. Unsure
5. Which of the following is TRUE regarding the use of atezolizumab and nab-paclitaxel in metastatic triple-negative breast cancer?
A. Overall survival was significantly extended in the intent-to-treat (ITT) population, including both PD-L1–positive and –negative tumors
B. In PD-L1–positive tumors, overall survival was approximately the same for atezolizumab + nab- paclitaxel and placebo + nab-paclitaxel
C. The progression-free survival benefit was observed in both PD-L1–positive and –negative tumors
D. There was no clinical benefit with the addition of atezolizumab to nab-paclitaxel in PD-L1–negative tumors
E. Unsure
6. Sacituzumab govitecan was approved for the treatment of metastatic triple-negative breast cancer (mTNBC). Which of the following is TRUE regarding sacituzumab govitecan?
A. It is approved by the United States Food and Drug Administration as first-line treatment of mTNBC, regardless of PD-L1 status
B. Premedication with acetaminophen, H1 and H2 antagonists, and anti-emetics, including dexamethasone and a 5HT-3 antagonist, is recommended
C. It has a low incidence of neutropenia
D. It is considered an immune checkpoint inhibitor
E. Unsure
7. According to data from the Keynote-355 trial, which of the following statements is TRUE regarding the addition of pembrolizumab to chemotherapy for first-line treatment of triple-negative breast cancer (TNBC)?
A. Pembrolizumab + chemotherapy significantly improved progression-free survival (PFS) compared with chemotherapy alone as first-line therapy in patients with metastatic TNBC (mTNBC) (PD-L1 CPS ≥10)
B. PFS was not improved with the addition of pembrolizumab in the PD-L1 CPS ≥1 group
C. Grade 3–5 treatment-related adverse event rates were significantly higher in the pembrolizumab arm
D. The chemotherapy studied in the trial included eribulin, paclitaxel, and nab-paclitaxel
E. Unsure
8. Which of the following is NOT a role that pharmacists can play in the management of patients with triple-negative breast cancer?
A. Review medications to identify patients who may or may not be a candidate for immune checkpoint inhibitor therapy
B. Counsel patients to aid in managing patient expectations, encourage adherence, and facilitate early detection of adverse events
C. Facilitate insurance appeals and peer-to-peer conversations
D. Educate clinicians that most patients taking olaparib have limited nausea and vomiting and that anti-emetic prophylaxis is not needed
E. Unsure
Evaluation Questions
9. How confident are in your treatment choice for MM?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
10. How confident are in your treatment choice for CC?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident