Copy of Medical Oncology Module 1

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 55 year old presents with orthopnea and paroxysmal nocturnal dyspnea. She has a history of breast cancer treated with chemoradiotherapy and surgery 10 years ago. She has no known cardiac risk factors.
On examination, her apex beat is displaced to the 6th intercostal space in the mid axillary line.She has bibasal crackles on auscultation. She receives treatment with frusemide with good effect.

Which chemotherapeutic agent is responsible for her condition?

A 78-year-old man presents with multiple sites of significant bone pain due to metastatic prostate cancer. He refuses bilateral orchidectomy. A decision is made to start a luteinising-hormone releasing-hormone (gonadotrophin-releasing hormone) agonist.

Which one of the following best describes the likely subsequent clinical events?

A 70 year old man has a diagnosis of castrate resistant metastatic prostate cancer with metastasis to the nodes and bones. He has been started on oral Abiraterone 1g daily along with prednisone 5mg twice daily.

What is the rationale for giving prednisone together with Abiraterone?

What is the mechanism of action of Ipilimumab?

A 71-year-old woman, who lives alone, presents to the Accident and Emergency Department with a history of increasing back pain over two months. The X-ray obtained is shown below.

What is the most likely diagnosis?

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?

In a post-menopausal patient, which one of the following is the best initial hormonal therapy for hormone receptor-positive metastatic breast cancer?

What is the most common side effect of Osimertinib?

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?

Among the following malignancies and its associated tumour markers, which one predicts the best overall prognosis with the normalisation of its tumour marker?

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?

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

A 48-year-old postmenopausal woman.Recent diagnosis of breast cancer.Annual screening shows dense breasts with a new 1.5-cm area of microcalcifications in the left breast without any associated mass. Biopsy revealed grade 2, ER/PR negative and HER2-negative infiltrating ductal carcinoma. Has maternal aunt with breast cancer diagnosed at age 50 years. She is otherwise healthy. Her physical examination is normal except for ecchymosis at the biopsy site.

Which of the following is the most appropriate next step in management?

You are seeing a 32 year old lady with early breast cancer in your clinic. She has recently undergone a breast conservation surgery. The tumor is 2cm.ER negative, PR negative,HER-2 positive. Well differentiated ductal carcinoma.Node negative.

What is the best adjuvant treatment to improve her overall survival?

With regards to cancer screening, which of the following cancer is routinely recommended in Australia?

A 62 year old lady has been newly diagnosed with metastatic breast cancer with liver metastasis. The tumor is 4cm.ER positive, PR negative and HER-2 positive. Grade 2 moderately differentiated lobular carcinoma with two positive nodes.

What is the best initial hormone therapy?

In premenopausal women with early breast cancer.

Which medication should be avoided?

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

The use of HRT increases the risk of which cancer?

Long term use of Tamoxifen is associated with increased risk of which cancer?

Raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer.

What is the main benefit of choosing Raloxifene over Tamoxifen?

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?

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