Medical Oncology Module 1

A 60-year-old patient with unresectable, limited-stage small cell lung cancer has completed concurrent chemoradiation without experiencing progression.

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

Consolidation with durvalumab for 2 years or until progression

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Observation with regular follow-up

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Additional chemotherapy with a different regimen

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Radiation therapy boost to the primary tumor site

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Surgical resection of the primary tumor

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A 45-year-old non-smoker Filipino woman presents with a lung mass that is initially diagnosed as squamous cell carcinoma on biopsy. However, the pathologist also notes that the tumor has some glandular features.

As part of the diagnostic workup, molecular testing for targetable mutations is being considered.

Which of the following is the most appropriate next step in evaluating this tumor for potential molecular targets?

Perform IHC for ROS-1, EGFR, and ALK to evaluate for potential molecular targets.

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Perform PCR-based molecular testing for EGFR mutations directly on the biopsy specimen.

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Perform fluorescence in situ hybridization (FISH) for ALK rearrangements on the biopsy specimen.

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Perform immunohistochemistry (IHC) for TTF-1, p63, and markers of adenocarcinoma to rule out adenosquamous carcinoma.

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Perform next-generation sequencing (NGS) on the biopsy specimen to detect multiple mutations simultaneously.

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What type of lung cancer is characterized by the expression of Delta-like 3 (DLL3)?

Small cell lung cancer (SCLC)

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Large cell neuroendocrine carcinoma (LCNEC) of the lung

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Adenocarcinoma of the lung with ALK rearrangements

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Squamous cell carcinoma of the lung

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Non-small cell lung cancer (NSCLC) with EGFR mutations

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Which of the following compounds found in cigarette smoke is considered the most potent and widely recognized carcinogen, particularly due to its role in the formation of DNA adducts leading to mutagenesis?

Polycyclic Aromatic Hydrocarbons (PAHs)

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Nicotine

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Carbon Monoxide

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Tobacco-specific nitrosamines (TSNAs)

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Acrolein

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Which of the following substances found in e-cigarette vapour is classified as a known carcinogen?

Formaldehyde

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Water Vapor

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Vegetable Glycerin

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Propylene Glycol

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Flavouring Agents

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Based on the findings from a randomised trial involving high-risk male former and current smokers, what was the observed impact of volume-based, low-dose computed tomographic (CT) screening on lung-cancer mortality at 10 years of follow-up?

A 24% reduction in lung-cancer mortality in the screening group compared to the control group

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No significant difference in lung-cancer mortality between the screening and control groups

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A 12% increase in lung-cancer mortality in the screening group compared to the control group

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A 52% reduction in lung-cancer mortality in the screening group compared to the control group

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Lung-cancer mortality was unaffected by adherence to CT screening protocols

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What is the mechanism of action of Ipilimumab?

A fully human monoclonal antibody that binds to cytotoxic T lymphocyte-associated antigen 4 (CTLA-4)

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A humanized monoclonal antibody that binds to tumor necrosis factor-alpha (TNF-alpha)

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A monoclonal antibody that interferes with the human epidermal growth factor receptor 2 (HER2/neu)

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A recombinant humanised monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor A (VEGF-A)

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A chimeric monoclonal antibody that binds to epidermal growth factor receptor (EGFR)

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What is the most common side effect of Osimertinib?

Diarrhoea

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Constipation

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Interstitial lung disease

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Fatigue

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Cardiotoxicity with QT prolongation

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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?

Bevacizumab, Cisplatin and Pemetrexed.

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Nivolumab and Ipilimumab

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Bevacizumab, Nivolumab and Pemetrexed

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Bevacizumab and Pemetrexed

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Gemcitabine and Carboplatin.

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A 60 year old Chinese woman who is a lifelong 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?

EGFR mutation and Osimertinib

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KIT mutation and Imatinib

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BRAF mutation and Dabrafenib

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KRAS mutation and Erlotinib

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Oestrogen receptor and Aromatase Inhibitor

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Denosumab is a fully human monoclonal antibody that is recognized to be effective in the prevention of skeletal-related events in patients with bone metastases from solid tumors.

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

no dose adjustment required for patients with renal impairment.

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lower risk of hypocalcemia

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does not cause osteonecrosis of the jaw

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can be administered once monthly rather than daily.

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lesser risk for skin infection

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A 40 year old woman, usually fit and well presents with a month’s history of abdominal pains associated with malaena and haemetemesis. 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?

KIT

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BRAF

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KRAS

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EGFR

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PDGFRA

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A 16 year old man with neuroblastoma is having treatment with chemotherapy.

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

vincristine

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cyclophosphamide

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cytosine arabinoside

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ifosfamide

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methotrexate

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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?

Rapid clinical deterioration and a marked increase in tumor burden shortly after initiating ICI therapy.

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A gradual increase in tumor size consistent with the expected progression of her underlying cancer.

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Rapid clinical deterioration and a marked increase in tumor burden shortly after stopping ICI therapy.

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Stabilization of tumor size with intermittent periods of slight increase in tumor burden.

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Development of new, treatment-responsive lesions without an overall increase in tumor burden.

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

Lorlatinib

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Crizotinib

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Erlotinib

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Sunitinib

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Dabrafenib

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

Palmar-plantar erythrodysaesthesia

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Hot flushes

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Vaginal dryness

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Osteoporosis

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Adverse lipid profile

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

Further immunohistochemistry testing reveals the following:

ALK negative
BRAF negative
EGFR negative
RET fusion positive
PD-L1 negative
ROS1 negative

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

Selpercatinib

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Osimertinib

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Pembrolizumab

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Alectinib

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Crizotinib

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In the management of stage IV non-small cell lung cancer (NSCLC), why is next-generation sequencing (NGS) particularly important?

To identify actionable genetic mutations for targeted therapy

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To confirm the histopathological diagnosis of NSCLC

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To determine the need for surgical resection

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To assess the patient's suitability for whole brain radiation therapy

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To evaluate the effectiveness of traditional chemotherapy regimens

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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?

Pemetrexed and a platinum-based drug combined with pembrolizumab

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Pemetrexed and a platinum-based drug without pembrolizumab

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Pembrolizumab monotherapy

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Palliative radiotherapy only

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Targeted therapy based on EGFR mutations

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

Osimertinib plus chemotherapy (Pemetrexed plus Cisplatin or Carboplatin)

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Osimertinib monotherapy

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Platinum–pemetrexed chemotherapy alone

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Afatinib monotherapy

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Amivantamab plus lazertinib

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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?

Neoadjuvant chemotherapy alone followed by surgery

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Neoadjuvant pembrolizumab plus chemotherapy followed by surgery and adjuvant pembrolizumab

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Neoadjuvant pembrolizumab alone followed by surgery

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Surgery followed by adjuvant pembrolizumab plus chemotherapy

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Surgery followed by adjuvant chemotherapy alone

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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 4 cm 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, PD-L1 <1%

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

Adjuvant Alectinib

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Adjuvant Selpercatinib

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Adjuvant Platinum-based chemotherapy

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Adjuvant Pembrolizumab

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Adjuvant Osimertinib

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A 75-year-old female with a history of severe COPD presents with a newly diagnosed 2 cm peripheral non-small cell lung cancer (NSCLC) in the right lower lobe.

Pulmonary function tests reveal a FEV1 of 40% predicted, and the patient is deemed a high-risk candidate for surgical intervention.

What is the most appropriate management option for this patient, considering her underlying comorbidities and the stage of her lung cancer?

Stereotactic ablative radiotherapy (SABR)

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Video-assisted thoracoscopic surgery (VATS) lobectomy

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Open lobectomy

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Palliative care only

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Chemotherapy

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Based on a study that evaluated the efficacy of adjuvant atezolizumab after platinum-based chemotherapy in early-stage NSCLC, what was the impact of atezolizumab on disease-free survival in the stage II–IIIA population whose tumors expressed PD-L1 on 1% or more of tumor cells?

Atezolizumab significantly increased disease-free survival compared to best supportive care in patients with PD-L1-positive tumors.

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Atezolizumab significantly decreased disease-free survival compared to best supportive care in patients with PD-L1-positive tumors.

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Atezolizumab showed no significant difference in disease-free survival compared to best supportive care.

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Atezolizumab significantly increased disease-free survival in all patients regardless of PD-L1 expression.

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Atezolizumab significantly increased disease-free survival only in patients with PD-L1-negative tumors.

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A 68-year-old male smoker presents with a persistent cough and unintentional weight loss. A chest radiograph reveals a suspicious 3 cm mass in the right upper lobe.

Further evaluation with CT scan shows no evidence of mediastinal lymphadenopathy.

A CT guided lung biopsy of the right upper lobe mass has been confirmed as TTF1 positive lung adenocarcinoma.

The next best step in the management of this patient to assess the extent of disease would be:

Positron Emission Tomography-Computed Tomography (PET-CT)

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Immediate surgical resection

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Bronchoscopy with biopsy

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Mediastinoscopy with lymph node sampling

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Refer for whole body CT scan

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Nivolumab is a fully human 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?

PD-1

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CTLA-4

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CD52

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CD20

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CD28

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Which of the following is NOT a recognized risk factor for cutaneous melanoma?

Dark skin

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Blonde hair

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Fair skin

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Immunosuppression

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Presence of dysplastic naevi

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

Metastatic melanoma

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Lung cancer

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Metastatic colorectal cancer

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Prostate cancer

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Non-Hodgkin's Lymphoma

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Which of the following mutations is primarily associated with the molecular drivers of cutaneous melanoma?

BRAF

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GNAQ

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GNA11

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G proteins

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SF3B1

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Which of the following oral kinase inhibitors is correctly matched with its target receptor?

Dabrafenib – BRAF inhibitor

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Vemurafenib – MEK inhibitor

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Cobimetinib – BRAF inhibitor

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Encorafenib – MEK inhibitor

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Trametinib – BRAF inhibitor

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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?

Combination of PD-1 inhibitor and BRAF inhibitor (BRAFi)

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MEK inhibitor (MEKi) monotherapy

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Combination of CTLA-4 and PD-1 inhibitors

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Combination of BRAF inhibitor and MEK inhibitor (BRAFi + MEKi)

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Combination of PD-1 inhibitor and MEK inhibitor

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A 45-year-old woman with metastatic melanoma has been started on a combination therapy of dabrafenib and trametinib. She has a past medical history of hypothyroidism, which is well controlled with levothyroxine. She has no known drug allergies. After initiating treatment, she returns to the clinic for a follow-up visit. During the evaluation, she reports experiencing a new side effect since starting the therapy.

Based on the adverse events profile for the combination of dabrafenib and trametinib in the treatment of metastatic melanoma, which of the following is the most common side effect that she is likely to report?

Fever

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Hand-foot syndrome

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Cutaneous squamous-cell carcinoma

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Decrease in ejection fraction

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Dermatitis acneiform

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A 63-year-old female with advanced melanoma, refractory to initial anti–PD-1 therapy, presents for consideration of further treatment options. She has a performance status of 1 and her serum lactate dehydrogenase (LDH) levels are within normal limits. Her melanoma does not harbor a BRAF V600 mutation. She participated in a phase 3, multicenter, randomized trial where she was assigned to receive T-cell infusion (TIL) therapy as a second-line treatment. The patient is interested in understanding the efficacy of her assigned treatment compared to traditional therapies such as ipilimumab.

Which of the following statements best reflects the findings related to progression-free survival (PFS) for TIL therapy?

The progression-free survival was more than twice as long in the TIL group compared to the ipilimumab group.

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TIL therapy did not significantly affect the progression-free survival when compared to ipilimumab.

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TIL therapy and ipilimumab showed similar progression-free survival rates at the 6-month mark post-treatment.

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TIL therapy showed a 30% lower progression-free survival rate compared to ipilimumab at 6 months.

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Progression-free survival with TIL therapy was less than that of ipilimumab treatment.

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What is the primary role of neoadjuvant nivolumab plus ipilimumab in the management of resectable stage III melanoma?

It is administered before surgery to induce tumour regression, eradicate micrometastatic disease, and improve event-free survival.

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It is administered after complete surgical resection as standard adjuvant therapy for all patients with stage III melanoma.

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It is used to downstage unresectable melanoma to allow palliative surgery.

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It replaces the need for complete lymph node dissection in patients with clinically node-positive disease.

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It is indicated only in patients with BRAF V600-mutant melanoma.

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Medical Oncology Module 1

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