Medical Oncology Module 1

What is the mechanism of action of Ipilimumab?

What is the most common side effect of Osimertinib?

A 65 year old man has been newly diagnosed with advanced unresectable (non-epithelioid) malignant pleural mesothelioma.

Which combination of treatment is likely to increase his overall survival?

A 60 year old Chinese woman who is a life long non-smoker presents with 3 months history of back pain. On staging CT she is found to have a large right lower lobe mass with evidence of bony metastases.
The biopsy of this mass shows a poorly differentiated adenocarcinoma.

What would be the most likely molecular mutation to be present in this lady and the best treatment option?

What is the most common mechanism of drug resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in patients who have lung cancer with an EGFR mutation?

Denosumab is a fully human monoclonal antibody that has been recently recognized to be effective in the prevention of skeleton-related events in patients with bone metastastes from solid tumors.

What is the main advantage of this agent compared to biphosphonates?

A 40 year old woman, usually fit and well presents with a month’s history of abdominal pains associated with malena and hemetemesis. Her abdominal CT scan shows a 13cm tumour arising from the duodenal wall and a further 4cm liver lesion in segment 8. The history is consistent with CD117 positive gastrointestinal stromal tumour of duodenum.

Given this clinical scenario, which of the following molecular marker is most likely to be mutated?

A 56 year old man with neuroblastoma is having treatment with chemotherapy.

If a leakage of the drug occurs, which one of the following chemotherapy drug is most likely to cause vesicant extravasation?

A 55-year-old woman with a history of non-small cell lung cancer is undergoing treatment with immune checkpoint inhibitors (ICIs). After starting therapy, her clinical condition rapidly deteriorates over 8 weeks, with significant increases in tumor size and the appearance of new metastatic lesions on imaging.

Which of the following clinical features would make hyperprogressive disease (HPD) the most likely diagnosis in this patient?

In a previously untreated advanced ALK-positive non-small cell lung cancer, which of the following targeted cancer therapy would be most effective?

Which of the following is a known side effect of Lapatinib?

A 63 year old man has just been diagnosed with advanced non-small cell lung cancer with brain metastases.

Further immuno-histochemistry testing reveals the following mutation:

• ALK negative
• BRAF negative
• EGFR negative
• RET fusion positive
• PDL-1 negative
• ROS1 negative

Which of the following treatment would he most likely respond to?

A 63-year-old male with a 40-pack-year smoking history presents with unintentional weight loss, persistent cough, and shortness of breath. A biopsy from a bronchoscopy confirms metastatic nonsquamous non-small cell lung cancer (NSCLC) without EGFR or ALK mutations. PD-L1 expression is noted to be 40% on tumor cells.

What would be the most appropriate first-line treatment for this patient?

What is the optimal first line treatment for patients with EGFR (exon 19 deletion or L858R mutation) mutated advanced NSCLC?

A 55-year-old male patient with a history of smoking presents to the oncology clinic with a recent diagnosis of resectable stage IllA non-small-cell lung cancer (NSCLC).

He is being considered for peri-operative therapy.

Which of the following therapeutic strategies is most likely to improve his event-free survival?

A 50 year old male ex-smoker presents to your clinic with 3 months history of persistent cough and unexplained weight loss. A chest x-ray requested by his GP last week suggested a possible lesion in the right upper lobe. A CT scan confirms the presence of a 4cm right upper lobe lesion which appears highly suspicious for a primary lung malignancy.

He was then referred for a PET CT for further staging.

His PET scan shows a strongly avid lesion in the right upper lobe but without any lymph node or metastatic disease.

Functionally, he has an ECOG score of 1 with excellent exercise tolerance.

He then proceeds to curative surgery with a right upper lobectomy.

Lung histology confirms the diagnosis of non-small cell lung cancer with the following immunohistochemistry:

• ALK positive
• EGFR negative
• RET negative
• PDL1 <1%

Following surgery, which of the following intervention would likely improve his survival?

Nivolumab is a novel humanized antibody that has been shown to be effective in the treatment of ipilimumab-refractory melanoma.

Which of the following is the target receptor for this agent?

Adoptive cell therapy with Tumor Infiltrating Lymphocytes (TILs) have shown promising results in the treatment of which malignancy?

A 58-year-old male presents to the oncology clinic with a confirmed diagnosis of metastatic melanoma. The patient has a history of a pigmented lesion on his back, which was surgically excised two years ago. He recently noted the development of new, painless, subcutaneous nodules on his abdomen and underwent a biopsy. Histopathological examination revealed malignant melanoma, and subsequent staging workup including a PET-CT scan confirmed multiple metastatic lesions in the liver and lungs.

The patient’s medical history is significant for hypertension, which is well-controlled on medication, and he has no known drug allergies. He has a family history of non-melanoma skin cancer but no known family history of melanoma or other hereditary cancers. The patient is a retired teacher, lives with his wife, and is a non-smoker with occasional alcohol use.

Molecular testing of the melanoma tissue did not detect a BRAF mutation; thus, the melanoma is classified as BRAF -ve. His performance status is good, and he expresses a willingness to undergo treatment. 

Considering the patient’s BRAF mutation-negative status, which of the following treatment options is most appropriate for this patient?

What is the role of Neoadjuvant Nivolumab and Ipilimumab in the treatment of Resectable Stage Ill Melanoma?