ESMO examination trial questions

In which case does the molecular aberration occur with a frequency of 80%?

A 74-year-old woman presented with pain at the right side of her abdomen due to hepatomegaly. Further investigations revealed multiple liver metastases of a poorly differentiated adenocarcinoma, no primary tumour detected by PET scan. Her WHO performance status is 3.

Which is the most appropriate approach?

Which of the following cancer drugs is an antimetabolite?

Which recommendation do you give to patients after successful treatment of early breast cancer?

A 30-year-old man presents with increasing weakness of the right arm for the last 4 weeks. An MRI of the brain shows a 2 cm contrast enhancing mass on the left parietal lobe with oedema. A surgical biopsy reveals a glioblastoma. His ECOG performance status is 1 and he has no comorbidities.

What is NOT part of management?

A 25-year-old male patient is diagnosed with a melanoma. Resection shows a pT2a pN0(sn) M0 R0 tumour with Breslow 1.2 mm and a BRAF V600E mutation.

Which is the correct management?

A 68-year-old patient is diagnosed with squamous cell cancer of the lung cT3 cN2 M1 (liver, adrenal gland and pleura). He is disoriented and aggressive. An MRI of the brain shows no metastases. Earlier, he showed an adequate behaviour, he does not take any medication.

What is the most likely explanation for his symptoms?

You have a new patient with locally advanced NSCLC stage IIIB. Histology is squamous cell cancer. PD-L1 expression is 5%. He has been treated with chemoradiotherapy 60 Gy concurrently with 3 cycles of cisplatin plus vinorelbine. He achieved partial remission as a result. Performance status is 1 ECOG, he is former smoker.

What is the most appropriate approach next?

A 52-year-old man is newly diagnosed with metastatic colon cancer in the coecum, multiple non-resectable liver, lung and peritoneal metastases. Molecular analyses show a tumour with a KRAS p.G12C mutation, wildtype for NRAS and BRAF, microsatellite-stable (MSS) and HER2 negative.

Which is the most appropriate first-line treatment?

A 65-year-old man is diagnosed endoscopically with early-stage gastric cancer and is treated with endoscopic resection. Pathology of the resected specimen shows a 2.5 cm adenocarcinoma with mucosal depth of invasion and active Helicobacter pylori infection.

Which of the following interventions has been shown to decrease rates of metachronous gastric cancer and improve baseline stomach atrophy?

A 74-year-old man with a history of muscle-invasive urothelial cancer presents for follow-up 1 month after undergoing a radical cystectomy (pT3 pN0). The patient has a creatinine clearance of 45 mL/min. He is well recovered, ECOG PS 1.

What is the most appropriate adjuvant treatment? 

What is the correct association between target and drug?

A 71-year-old man with several comorbidities (diabetes, polyneuropathy, coronary heart disease) was diagnosed with a large mass in the liver. Biopsy showed adenocarcinoma consistent with a colon primary tumour, which was found in the coecum. Molecular profiling shows a KRAS mutation (G12A) and MSI-h.

Which is the most appropriate treatment for this patient?

Which of the following immune-related adverse events occurs least frequently during immunotherapy with checkpoint inhibitors?

A 62-year-old man was diagnosed with metastatic gastric cancer (extensive peritoneal carcinomatosis); histology showed an undifferentiated adenocarcinoma with signet cell features, MSS, HER2 negative and a PD-L1 expression (CPS) of 25.

What is the preferred first-line therapy according to the ESMO guidelines?

Which of the following statements is correct regarding a maintenance therapy with 5-FU plus bevacizumab in metastatic colorectal cancer?

A 72-year-old patient presented with increasing pain in his right arm for the last 6 weeks. An X-ray showed a destructive mass of 7 cm in the distal right humerus. The patient is in a good performance status, has no comorbidities but for chronic reflux disease treated with proton-pump-inhibitors. Clinical examination shows no abnormalities apart from the pain in the right arm. Histopathological examination of the tumour mass reveals diffuse large B-cell lymphoma.

Which is the most appropriate imaging assessment?

A 55-year-old postmenopausal woman presented with high-risk breast cancer pT3 G3, pN2, cM0, ER 30%, PgR 0%, Ki67 22%, HER2 IHC 1+. She has been treated with breast-conserving therapy, adjuvant anthracycline and taxane-based chemotherapy and adjuvant radiotherapy.  A germline BRCA2-mutation was detected.

What is the most appropriate further treatment?

A 59-year-old patient was newly diagnosed with metastatic prostate cancer with multiple bone lesions (> 6) and enlarged retroperitoneal lymph nodes (up to 4 cm). There are no significant comorbidities except of arterial hypertension.

Which is the best treatment for this patient?

A 54-year-old woman was diagnosed with early breast cancer on the right side, 2.5 cm in largest dimension, HER2 positive, ER 90% PgR 80% positive, Ki-67 30%. Initially she underwent neoadjuvant treatment with 4 cycles of doxorubicin plus cyclophosphamide and then 12 weeks of weekly paclitaxel and trastuzumab/pertuzumab every 3 weeks. She underwent breast-conserving surgery. Pathologic complete remission was not achieved. Pathologic report specimen of the breast sample was HER2 negative, ER80% PgR70%, Ki-67 20%.

What is the most appropriate adjuvant treatment in addition to the planned aromatase inhibitor?

Which of the following statements about adjuvant therapy of biliary tract cancer is correct?

Which pharmacogenomic testing is recommended by EMA and FDA to estimate and avoid toxicity before the treatment start?

Regarding antibody-drug conjugates (ADC) for the treatment of metastatic breast cancer, which statement is FALSE?

A 51-year-old woman was diagnosed with endometrial cancer, endometroid subtype, Stage II Grade 3. Molecular pathological examination revealed POLEmut (polymerase epsilon-ultramutated).

Which further adjuvant approach after oncologic R0 resection is recommended?

A 55-year-old woman was diagnosed with endometrial cancer, endometroid subtype, stage I with myometrial invasion. Immunohistochemistry revealed alteration of p53 (p53-abn).

Which is the best further adjuvant approach after oncologic R0-resection?

A 79-year-old woman is diagnosed with an adenocarcinoma of the lung (NCSLC) with pulmonary metastases.  PD-L1 TPS 10%. Next generation sequencing (NGS) shows a HER2 (ERBB2) mutation, and no other mutations. She was initially treated with carboplatin, pemetrexed and pembrolizumab followed by a maintenance therapy with pemetrexed and pembrolizumab for 5 months. Follow-up CT scan reveals a progression of the lung and adrenal metastases. 

Which of the following therapies has the highest response rate?

A 66-year-old male patient in otherwise good condition presents with cough and dyspnoea. CT scan shows a mediastinal mass with metastases to the left liver lobe and the left adrenal gland.

Histology from the primary tumour reveals small-cell lung cancer.

Which of the following recommendations by the interdisciplinary tumour board is according to the ESMO guidelines? 

A 67-year-old patient presents with widespread metastatic disease. A biopsy of a metastatic lesion shows an undifferentiated neoplasm. Immunohistochemistry shows: pan-keratin (AE1/AE3) negative; CD45 negative and SOX10 and S100 positive.

Which is the most probable diagnosis?

Which of the following is a requirement for a patient with uveal melanoma to be eligible for the treatment with tebentafusp?

What is the most recommended option for most patients with metastatic GEP NETs (gastro-entero-pancreatic neuroendocrine tumours) grade 1 and progressive disease despite a long-acting somatostatin analog and who have somatostatin receptor-positive disease with no underlying renal or hematologic insufficiency?

A 61-years-old woman is diagnosed with ER100%, PgR 85%, HER2 negative (IHC 1+) breast cancer with multiple bone, lung and at least 8 liver metastases. Except for intermittent lower back pain, she is asymptomatic and in excellent performance status without comorbidities.

Which of the following is the most appropriate treatment?

A 65-year-old patient was treated 5 months ago with definitive chemoradiotherapy for pharyngeal squamous cell carcinoma stage cT3 cN2 cM0. PD-L1 (CPS) status was 25. Now he presents with extensive ulcerative fixed relapse and cervical lymph node involvement without distant disease.

What is the most appropriate treatment option?

Which of the following targeted therapies is NOT ALK inhibitor?

A 74-year-old patient presents with a non-resectable cutaneous squamous cell carcinoma on his head (with involvement of the eyelid). ECOG Performance status 1.

Which treatment is most appropriate according to ESMO guidelines?  

Which type of drug is NOT used in first-line treatment of unresectable hepatocellular carcinoma?

Glofitamab is a CD20-targeted T-cell (CD3)–engaging bispecific antibody.

When used as a single agent in patients with refractory B-cell lymphoma, which of the following adverse events is most common?

What is the most appropriate management for T2N1 (FIGO stage II) squamous cell carcinoma of the cervix?

A 64-year-old man with ECOG PS 1 with a long-standing history of anal condylomas controlled with imiquimod, presents with anal squamous cell carcinoma, stage III, cT2cN2cM0, p16 and HPV positive.

What is the most appropriate treatment?

A 53-year-old woman with ECOG PS 0 presents with discrete odynophagia and slow growing bilateral cervical masses. Biopsy shows lymph node metastasis of squamous cell carcinoma, p16 and HPV positive. CT scan shows two mucosal lesions, one in the oropharynx another in the palatine amygdala.

What is the most appropriate conduct?

A 62-year-old man has been diagnosed with prostate carcinoma featuring widespread bone and lung metastases. He has a good performance status (ECOG 1) with no comorbidities. Subsequent studies reveal microsatellite instability-high (MSI-H) and wild-type (wt) BRCA1/2.

What would be the most suitable initial treatment option besides androgen deprivation therapy (ADT)?

A 52-year-old patient with metastatic urothelial carcinoma progressed upon first-line platinum-based therapy. Molecular testing revealed FGFR-3 fusion. Which treatment improves outcomes in this setting?

What is the mechanism of action of monomethyl auristatin E (vedotin)?

Which is the most effective treatment for breakthrough-induced nausea and vomiting for patients receiving standard prophylaxis for moderately emetogenic antineoplastic chemotherapy?

A 53-year-old woman is newly diagnosed with a triple negative metastatic breast cancer, grade 3.

Among the following treatments, which one is NOT an option (knowing that the patient has no imminent organ failure)?

Which one of the following strategies is NOT an option to manage a patient with localized, low risk prostate cancer?

Associate targeted drugs with their corresponding targets. Indicate which one of them is NOT a correct association.

What is the most common histologic subtype of malignant mesothelioma?

The absolute benefit for overall survival of adjuvant treatment of patients 80 years or older with resected breast cancer is lower than of younger patients < 70 years. What is the main explanation for this phenomenon?

A 32-year-old pregnant (14 weeks) woman was diagnosed with left-sided breast cancer. Clinically 3 cm, no palpable axillary lymph nodes, free supraclavicular region. Biopsy revealed invasive ductal carcinoma, grade 3, Ki67 70%, endocrine dependent (ER 100%, PR 70%), HER2 positive (IHC 3+). Laboratory workup: no major abnormalities, chest X-ray and liver sonography: no evidence of metastatic spread. What would be the most appropriate strategy?

A 51-year-old man is diagnosed with squamous cell carcinoma at the base of the tongue. Staging shows T2N2, ECOG PS 1 and normal renal function. What would be the recommended treatment?

Cachexia is a relevant problem in advanced cancer.

Which measure is recommended, if probability of survival is less than 3 months?

According to the ESMO Guidelines, which of the following treatment options is NOT recommended in breast-like CUP (Carcinoma of Unknown Primary) with isolated lymph node metastasis to the axilla and negative MRI of the breast?

What do Kaplan-Meier curves primarily depict in oncology studies?

In an oncological trial assessing the efficacy of a new treatment, the researchers decide to perform subgroup analyses.

What should be considered when interpreting subgroup analyses?

When managing cancer in older adults, which of the following is a crucial principle in treatment decision-making?

In a clinical trial investigating a new treatment, the 5-year survival was 80% in the experimental arm and 70% in the control arm.

A 37-year-old woman is diagnosed with a thymoma and curatively resected. Pathology shows: Thymoma, 10% type B1, 90% type B2, stage pT3 no lymphovascular invasion Pn0 R0, Masaoka-Koga stage III.

What post-operative treatment do you recommend according to the ESMO Guidelines?

A 72-year-old woman was operated on her squamous cell cancer of the middle oesophagus (staged cT3 cN1 cM0) after neoadjuvant chemoradiation analogous to the CROSS regimen pathological examination shows a ypT3 ypN0 (0/21) no lymphovascular invasion Pn1 R0, regression grade 3 (Mandard). Which adjuvant treatment do you recommend according to the ESMO Guidelines?

A 55-year-old woman was diagnosed with stage III high-grade serous ovarian cancer and underwent primary resection followed by standard chemotherapy. She is asymptomatic but during the follow-up period has an increasing tumour marker CA125. PET-CT imaging does not identify recurrent disease.

Which of the following is the best treatment approach?

Sacituzumab-govitecan and trastuzumab-deruxtecan are new antibody-drug conjugates used for treatment of breast cancer. They share some similarities. Which statement is correct?

A 62-year-old patient with metastatic colon cancer is scheduled for the second cycle of FOLFIRI-panitumumab. She reports that immediately after the last chemo administration she suffered acute abdominal cramps followed by 4 massive, watery bowel movements on her way home. She felt weak and light-headed for the rest of the day. Today, 14 days later, her lab tests show normal hepatic and renal function, a neutrophil count of 4.3 g/L (nadir at day 7: 0.6 g/L), haemoglobin of 134 g/L and thrombocyte count of 125 g/L (day 7: 105 g/L).

What is the most appropriate management for the second administration of FOLFIRI-panitumumab?

A 58-year-old, former alcoholic, presents with a large hepatic mass with portal vein infiltration and several bone metastases. Biopsy confirms the diagnosis of hepatocellular carcinoma. Liver function is Child-Pugh A. Which is the preferred treatment option according to the ESMO Guidelines?

Which statement concerning sacituzumab govitecan is NOT correct?

A 68-year-old woman with a good performance status and no relevant comorbidities was diagnosed with a HER2 positive, PD-L1 CPS < 1%, metastatic gastric adenocarcinoma with liver and peritoneal metastasis. She received cisplatin and 5-FU with trastuzumab as first-line therapy, with stable disease after 3 months. A CT scan after 5 months demonstrated progression of disease with increased size of liver metastasis. A second-line therapy with paclitaxel and ramucirumab was initiated. After 3 months a CT scan reveals progression with new lung metastasis. The patient is still in good performance status and is motivated to receive further therapy.

A new biopsy shows HER2-ISH amplification, which of the following would be the most appropriate treatment?

Which of the following therapies would you recommend for an 80-year-old fit male patient with inoperable periorbital basal cell carcinoma?

After several years of abdominal pain, flushing and diarrhoea, a 66-year-old man was diagnosed with a neuroendocrine tumour NET G1 (Ki67 1-2%) in the small bowel with multiple liver metastases. The tumour shows high intensity in the Ga-DOTATATE PET and an elevated 5-HIAA (5 hydroxy-indoleacetic acid) in the 24-hour urine.

What is the appropriate first-line treatment?

A 23-year-old patient suffers from a metastatic non-seminoma and is to receive 3 cycles of BEP with a curative intent (Bleomycin, Etoposide, Cisplatin). He tolerates the first cycle without major problems. On day 1 of cycle 2 he isafebrile and has normal vital signs but shows the following haematologic values: Hb 7.8 mmol/L (130 g/L); leukocytes 1.1x109/L, neutrophils 0.3x109/L; platelets 83x109/L.

How do you proceed?

The response rate of monotherapy with the checkpoint inhibitor nivolumab is the highest in:

A 70-year-old man presents with an enlarged right inguinal lymph node. No primary tumour is identified. Immunohistochemical analysis of the lymph node reveals the following pattern: cytokeratins-, LCA-, PSA-, vimentin+, HMB45+.

These findings are characteristic for:

In a 65-year-old male patient with a PS 1 a bronchial adenocarcinoma of the right upper lobe is found. The tumour measures 3.5 cm. PET-CT reveals metastases in the suprarenal glands, several vertebrae and 2 lesions in the liver. The patient is a heavy smoker (60 pack-years) and drinks 0.5 litre of red wine/day. He is known to have gout and mild cutaneous psoriasis. The PD-L1 expression in the tumour cells is 55%, no EGFR, ALK or ROS-1 mutations are found.

Which treatment will result in the best overall survival?

Which virus is most frequently involved in the pathogenesis of nasopharyngeal carcinoma?

A 70-year-old man was found to have a gastric GIST (gastrointestinal stromal tumour). Following submucosal tumour excision, the final classification was pT2 (2 cm), R0, mitotic activity < 5/50 HPF.

Which is the appropriate management?

Which of the following targeted therapies in stage IV NSCLC has the lowest CNS efficacy?

Which of the following treatment options is NOT standard in first-line therapy of oncogene-addicted stage IV NSCLC?

All of the following are common side-effects of the anti-emetic drug class serotonin 5-hydroxytryptamine (5HT3) antagonists, EXCEPT:

All of the following drugs are alkylating agents, EXCEPT:

Which of the following pairs is NOT a corresponding favorable CUP subtype according to the ESMO Guidelines?

Which of the following statements is NOT correct, regarding dihydropyrimidine dehydrogenase (DPYD) testing?

Which of the following statements regarding the treatment of follicular lymphoma (grade 1, 2) is NOT correct?