A 52-year-old woman with ER+/PR+/HER2- breast cancer (cT2N1M0) undergoes neoadjuvant chemotherapy with anthracycline-taxane regimen. Post-mastectomy pathology reveals residual disease in 2 sentinel nodes. According to the CREATE-X trial findings, which adjuvant treatment is NOW indicated?

• A Trastuzumab emtansine (T-DM1) for 14 cycles
• B Olaparib for 1 year
• C Abemaciclib for 2 years
• D Capecitabine for 6–8 cycles ✓

Explanation

The CREATE-X trial demonstrated that capecitabine given as adjuvant therapy after neoadjuvant chemotherapy in HER2-negative patients with residual invasive disease significantly improved disease-free and overall survival. T-DM1 is indicated for HER2+ residual disease (KATHERINE trial). Olaparib (OlympiA trial) is for BRCA-mutant HER2-negative high-risk patients. Abemaciclib (MonarchE) is a CDK4/6 inhibitor for node-positive HR+ HER2- high-risk patients in adjuvant setting but differs from CREATE-X population.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.