A 52-year-old woman with invasive ductal carcinoma (T2N1M0) undergoes neoadjuvant chemotherapy. Post-treatment pathology shows no residual invasive carcinoma in the breast or lymph nodes (ypT0ypN0). According to the CREATE-X trial findings, which additional therapy is indicated because she had residual disease at surgery?
- A No additional therapy is required given pathological complete response ✓
- B Capecitabine for 6–8 cycles
- C T-DM1 (trastuzumab emtansine) for 14 cycles
- D Olaparib for 1 year if BRCA-wild type
Correct answer: A. No additional therapy is required given pathological complete response
Explanation
The scenario describes pathological complete response (pCR: ypT0ypN0) after neoadjuvant chemotherapy — meaning NO residual disease. The CREATE-X trial showed that capecitabine improves outcomes in HER2-negative patients with residual disease (non-pCR) after neoadjuvant chemotherapy. Because this patient has achieved pCR, capecitabine is not indicated on that basis. T-DM1 is the standard for residual HER2-positive disease (KATHERINE trial). The question tests discrimination of pCR from residual disease.
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.