Medical Oncology Module 1

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

Polycyclic Aromatic Hydrocarbons (PAHs)
Nicotine
Carbon Monoxide
Nitrosamines
Acetaldehyde

Which of the following substances found in e-cigarette vapor has been identified as potentially harmful due to its known toxic effects when inhaled?

Formaldehyde
Water Vapor
Vegetable Glycerin
Propylene Glycol
Flavoring Agents

Based on the findings from a randomized 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
No significant difference in lung-cancer mortality between the screening and control groups
An 12% increase in lung-cancer mortality in the screening group compared to the control group
A 52% reduction in lung-cancer mortality in the screening group compared to the control group
Lung-cancer mortality was unaffected by adherence to CT screening protocols

What is the mechanism of action of Ipilimumab?

a humanized monoclonal antibody that binds to cytotoxic T lymphocyte associated antigen 4 (CTLA-4)
a humanized monoclonal antibody that binds to tumor necrosis factor-alpha (TNF-alpha)
a recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor A (VEGF-A)
a monoclonal antibody that interferes with the human epidermal growth factor receptor 2 (HER2/neu).
a chimeric monoclonal antibody that binds to epidermal growth factor receptor (EGFR)

What is the most common side effect of Osimertinib?

Rash
Diarrhea
Interstitial lung disease
Fatigue
Loss of appetite

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.
Nivolumab and Ipilimumab
Bevacizumab, Nivolumab and Pemetrexed
Bevacizumab and Pemetrexed
Gemcitabine and Carboplatin.

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?

EGFR mutation and Erlotinib
KIT mutation and Imatinib
B-RAF mutation and Dabrafenib
K-RAS mutation and Erlotinib
Oestrogen receptor and Aromatase Inhibitor

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?

Insurgence of secondary mutations in the EGFR gene (T790M mutation).
Phenotypic histological transformation from adenocarcinoma to small cell lung cancer.
Activation of alternative pathways by amplification of the MET oncogene.
Presence of a non-sensitive EGFR mutation causing intrinsic resistance
Point mutation in exon 19

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?

no dose adjustment required for patients with renal impairment.
lower risk of hypocalcemia
does not cause osteonecrosis of the jaw
can be administered once monthly rather than daily.
lesser risk for skin infection

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?

KIT
B-RAF
K-RAS
EGFR
PDGFRA

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?

vincristine
cyclophosphamide
cytosine arabinoside
ifosfamide
methotrexate

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.
A gradual increase in tumor size consistent with the expected progression of her underlying cancer.
Rapid clinical deterioration and a marked increase in tumor burden shortly after stopping ICI therapy.
Stabilization of tumor size with intermittent periods of slight increase in tumor burden.
Development of new, treatment-responsive lesions without an overall increase in tumor burden.

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

Alectinib
Crizotinib
Erlotinib
Sunitinib
Dabratinib

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

Palmar-plantar erythrodysthesia
Hot flushes
Vaginal dryness
Osteoporosis
Adverse lipid profile

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?

Selpercatinib
Osimertinib
Pembrolizumab
Alectinib
Crizotinib

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
To confirm the histopathological diagnosis of NSCLC
To determine the need for surgical resection
To assess the patient's suitability for whole brain radiation therapy
To evaluate the effectiveness of traditional chemotherapy regimens

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
Pemetrexed and a platinum-based drug without pembrolizumab
Pembrolizumab monotherapy
Palliative radiotherapy only
Targeted therapy based on EGFR mutations

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

Osimertinib plus chemotherapy (Pemetrexed plus Cisplatin)
Osimertinib monotherapy
Pembrolizumab plus chemotherapy (Pemetrexed plus Cisplatin)
Alectinib plus chemotherapy (Pemetrexed plus Carboplatin)

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
Neoadjuvant pembrolizumab plus chemotherapy followed by surgery and adjuvant pembrolizumab
Neoadjuvant pembrolizumab alone followed by surgery
Surgery followed by adjuvant pembrolizumab plus chemotherapy
Surgery followed by adjuvant chemotherapy alone

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?

Adjuvant Alectinib
Adjuvant Platinum based chemotherapy
Adjuvant Pembrolizumab
Adjuvant Selpercatinib

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)
Video-assisted thoracoscopic surgery (VATS) lobectomy
Open lobectomy
Palliative care only
Chemotherapy

Based on a recent 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, with a hazard ratio (HR) of 0.66.
Atezolizumab significantly decreased disease-free survival compared to best supportive care, with a hazard ratio (HR) of 0.66.
Atezolizumab showed no significant difference in disease-free survival compared to best supportive care.
Atezolizumab significantly increased disease-free survival in all patients regardless of PD-L1 expression.
Atezolizumab significantly increased disease-free survival only in patients with PD-L1-negative tumors.

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.

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)
Immediate surgical resection
Bronchoscopy with biopsy
Mediastinoscopy with lymph node sampling
Percutaneous needle biopsy of the lung mass

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?

PD-1
CTLA-4
CD52
CD20
CD28

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

Dark skin
Blonde hair
Fair skin
Immunosuppression
Presence of dysplastic naevi

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

Metastatic melanoma
Lung cancer
Metastatic colorectal cancer
Prostate cancer
Non-Hodgkin's Lymphoma

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

BRAF
GNAQ
GNA11
G proteins
SF3B1

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

Dabrafenib – BRAF inhibitor
Vemurafenib – MEK inhibitor
Cobimetinib – BRAF inhibitor
Encorafenib – MEK inhibitor
Trametinib – BRAF inhibitor

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 PD1 inhibitor and BRAF inhibitor (BRAFi)
MEK inhibitor (MEKi) monotherapy
Combination of CTLA4 and PD1 inhibitors
Combination of BRAF inhibitor and MEK inhibitor (BRAFi + MEKi)
PD1 inhibitor monotherapy.

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
Hand-foot syndrome
Cutaneous squamous-cell carcinoma
Decrease in ejection fraction
Dermatitis acneiform

A 52-year-old male with advanced melanoma has been undergoing treatment as part of a trial. He has a history of a BRAF mutation-positive melanoma and elevated lactate dehydrogenase (LDH) levels at the start of the trial.

The patient was randomized to receive nivolumab plus ipilimumab as per the trial protocol. He tolerated the induction phase without significant adverse effects and has completed 3 years of therapy. At his latest follow-up, the oncologist discusses long-term outcomes based on recent data from a similar trial (Checkmate 067).

Which statement best describes the 5-year overall survival outcome for this patient, considering his treatment with nivolumab plus ipilimumab?

The patient has a 60% chance of 5-year overall survival
The patient has a less than 25% chance of 5-year overall survival
The patient has a 34% chance of 5-year overall survival
The patient has a 46% chance of 5-year overall survival
The patient's 5-year overall survival cannot be determined from the trial data.

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.
TIL therapy did not significantly affect the progression-free survival when compared to ipilimumab.
TIL therapy and ipilimumab showed similar progression-free survival rates at the 6-month mark post-treatment.
TIL therapy showed a 30% lower progression-free survival rate compared to ipilimumab at 6 months.
Progression-free survival with TIL therapy was less than that of ipilimumab treatment.

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

It is given before surgery to reduce tumor burden and enhance the likelihood of complete resection.
It is not recommended due to lack of efficacy in this setting.
It is used to improve overall survival in patients with Resectable Stage Ill Melanoma.
It is used as adjuvant therapy following surgery to eliminate any residual cancer cells.
It is administered after surgery to prevent recurrence of melanoma.

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Medical Oncology Module 1

Medical Oncology Module 1

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