ESMO examination trial questions

TIL-transfer therapy and CAR-T cell therapy share many common features.

Which step is unique to CAR-T cell therapy?

Which of the following patients with cancer of unknown primary site (CUP) do NOT belong to a favourable prognostic subset?

Patients with…

An 82-year-old patient with diabetes mellitus type 2, hypertension and cardiac bypass surgery 5 years ago was referred because of locally advanced (non-resectable) squamous cell carcinoma on his scalp with enlarged neck lymph nodes. He cannot walk long distances (> 1km), lives by himself and is able to carry out light housework.

Which treatment is most appropriate?

Which is the most frequent endocrine adverse event with the use of PD-1 inhibitors?

A 28-year-old man underwent radical orchiectomy for pure seminoma. On the pre-operative CT scan two regional, retroperitoneal lymph nodes of 4 cm and 3 cm were detected. AFP was normal, LDH < 1.5 x ULN and beta-hCG was 30 U/L (normal < 2 U/L).

Which treatment is most appropriate?

Which association between PARP inhibitor and specific side effect is wrong?

Which of the following drugs has shown a significant increase of progression-free survival as a second-line therapy for metastatic, HER2 positive breast cancer patients compared with trastuzumab-emtansine (TDM-1)?

Which of the following data are NOT considered in scoring the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) of randomized controlled trials?

Mammography screening in the average-risk female population aged 50-70 years is associated with both benefits and risks.

Which of the following is the most important cause of harm?

A 53-year-old man has completed chemoradiotherapy for PD-L1-positive stage IIIB Adeno-NSCLC. Staging CT reveals partial remission.

Which is the most appropriate further management?

Which of these agents is the preferred option to increase overall survival for patients with urothelial carcinoma progressing following platinum-based chemotherapy and immunotherapy regardless of the FGFR status?

An 83-year-old woman was admitted to the hospital with sharp pain in the left groin as well as diffuse abdominal pain, drenching night sweats, fatigue and 7 kg weight loss during the previous 3 months. Physical examination revealed a 6 cm left inguinal mass and bilateral axillary and cervical lymphadenopathies. PET-CT scan demonstrates diffuse lymphadenopathies as well as splenomegaly. The patient undergoes an excisional biopsy of a lymph node that shows a diffuse large B-cell lymphoma, germinal center B (GCB) subtype, without evidence of a MYC or BCL6 rearrangement. Haematological findings and viral markers for HIV and hepatitis were unremarkable. ECOG Performance Status was 1. She has a history of type 2 diabetes and hypertension.

What is the most appropriate treatment?

A 48-year-old woman underwent surgery for ovarian cancer FIGO stage IIIB. Molecular analyses showed no BRCA mutation (germline or somatic) but showed a homologous recombination deficiency (HRD). Six cycles of carboplatin, paclitaxel and bevacizumab were administered, and re-staging showed no evidence of disease.

What is the most appropriate management?

A 52-year-old otherwise healthy man was diagnosed with anal cancer. Biopsy revealed a p16-positive squamous cell cancer with EGFR overexpression and staging (MRI and PET) showed a stage III.

 Standard treatment is chemoradiation…

A 60-year-old man was diagnosed with a distal rectal cancer, initially staged as cT3 cN2b cM0, MRF (mesorectal fascia) involved. He was treated with a short course radiotherapy (5x5 Gy) followed by six cycles of CAPOX. Then a TME (total mesorectal excision) surgery was performed, and the pathology report stated a complete pathologic response ypT0 ypN0 (0/17) R0, MERCURY I.

Which adjuvant treatment is most appropriate?

A 63-year-old man was diagnosed with a metastatic small bowel neuroendocrine tumour (NET) in 2014. Because of a carcinoid syndrome, he has been treated since diagnosis with octreotide LAR 30 mg every 4 weeks. He was clinically and biochemically well-controlled and radiologically stable. In June 2021 he requested a treatment stop and within 2 months, the carcinoid syndrome re-occurred.

What is the most appropriate management?

A 69-year-old man was diagnosed with a gastrointestinal stromal tumour (GIST) of the stomach with liver and peritoneal metastases in 2017. Molecular analyses revealed a KIT mutation in exon 11. Because of side effects he is treated with a reduced dose of imatinib 200 mg per day. The CT scan shows a stable cystic residuum in the liver.

Which is the appropriate further management?

A 62-year-old man undergoes laparoscopic cholecystectomy for symptomatic gallbladder stones. Pathology assessment shows an invasive T3 adenocarcinoma in the gallbladder. A CT scan reveals no metastases.

Which of the following is the best next step in the management of this patient's disease?

A 43-year-old man receiving pembrolizumab as adjuvant treatment for stage III melanoma develops grade 3 immune-related hepatitis after 4 months of treatment.

What is the best management once hepatitis is resolved?

A 37-year-old woman was diagnosed with metastatic adenocarcinoma of the cervix, PD-L1 negative. She now suffers disease progression 6 months after platinum-based chemotherapy. ECOG performance status is 1, organ functions are normal. Which of the following treatments is most appropriate?

Regarding Hodgkin lymphoma, what is correct?

Which of the following is the most reliable indicator of pain?

A patient with newly diagnosed stage IV adenocarcinoma of the lung should be treated with systemic therapy.

Which information about the tumour is NOT necessary for the choice of first-line treatment?

Adjuvant chemotherapy should be offered to fully staged patients with early stage ovarian cancer (stage I–IIA), EXCEPT:

Many orally administered drugs should not be taken together with grapefruit juice.

Which pharmacokinetic process is mainly affected by this interaction?

A patient with small and fragile veins needs to start systemic treatment in the outpatient setting. Peripheral vein access for iv-infusion is difficult, but usually possible after two or three attempts. The patient is reluctant to obtain a central venous access.

For planned repeated administration of which of the following drugs is a central venous access strongly recommended despite the patient’s reluctance?

A 64-years-old patient with metastatic ER positive, PR positive, HER2 negative breast cancer is treated with fulvestrant and a CDK4/6-inhibitor. After 8 months of stable disease, re-staging shows progression with 5 new liver metastases and unchanged bone metastases. ECOG performance status is 1. Laboratory values are normal except for mildly increased serum levels of ASAT and ALAT (1.8xULN).

What is the most appropriate next step?

Which is NOT a typical side effect of bleomycin?

Which of the following statements about adrenocortical carcinoma (ACC) is FALSE?

A 75-year-old man was referred because of an elevated PSA serum level (16 ng/ml). He has no specific complaints.

Which is the most appropriate first diagnostic procedure?

A 54-year-old woman presents with chest pain and shortness of breath. CT scan showed multiple pleural and lung metastases. A biopsy of an enlarged axillary lymph node was performed and showed an ER negative, PR negative, HER2 positive breast cancer.

Which is the most appropriate first-line therapy?

Which of the following are the best validated prognostic factors for GIST?

Which of the following ALK inhibitors most frequently causes visual disturbances?

A 55-year-old man with newly diagnosed non-small-cell lung cancer (NSCLC) of the left upper lobe reports constant sweating of the left forehead.

Which lesion explains this patient‘s symptom?

A 67-year-old patient with newly diagnosed chronic lymphocytic leukaemia (CLL) with a deletion del(17p) and several comorbidities needs a first-line treatment.

What is the most appropriate treatment?

A 64-year-old man with a locally advanced laryngeal carcinoma underwent total laryngectomy. Due to extracapsular spread he received adjuvant chemoradiation. He completed his therapy 10 months ago. In the follow-up consultation he complains about severe fatigue, forgetfulness and dry skin. He has a dry mouth, but he can eat solid food.

Which of the following is the most appropriate next step?

A 30-year-old previously healthy woman presents with shortness of breath and chest pain. She also reports night sweats for the past three weeks. On physical exam, she has mild lymphadenopathy of the left cervical chain, no hepatosplenomegaly.

Her labs were normal. A CT scan reveals a 7 cm mediastinal mass and left cervical lymphadenopathy. A biopsy of the mediastinum was performed and shows classical Hodgkin lymphoma. Availability of PET and CT at the treating centre are no issue.

According to the PET-guided approach of the ESMO guidelines, at what intervals should PET and CT scans be done for this patient?

A 75-year-old man presented to his family doctor due to progressive fatigue. The laboratory analyses reveal a lymphocytosis of 100 x10⁹/L (normal 1.0-4.8), haemoglobin of 85 g/L (normal 120-160) and platelets of 60 x10⁹/L (normal 150-450). Further studies confirm the diagnosis of a chronic lymphatic leukaemia (CLL).

Which of the following factors is associated with a very good clinical outcome?

A 79-year-old man is diagnosed with diffuse large B-cell lymphoma (DLBCL), Ann Arbor stage IIIA. Comorbidities are diabetes mellitus, arterial hypertension. He suffered a stroke 5 years ago without persisting neurological deficit. Left ventricular ejection fraction is 55%, creatinine clearance is 55 ml/min. A geriatric assessment shows the following:

The Follicular Lymphoma International Prognostic Index (FLIPI) allows a prognostic differentiation in 3 risk categories concerning the risk of relapse.

Which is NOT a risk factors in this score?

A 69-year-old man is newly diagnosed with metastatic, EGFR-mutated non-small-cell lung cancer with PDL-1 expression of 60%.
What is the most appropriate first-line treatment?

Which of the following targeted agents used in advanced breast cancer treatment is associated with an increased risk of venous thromboembolism (VTE)?

A 72-year-old man with extensive disease small-cell lung cancer (SCLC) is treated with cisplatin plus etoposide. His ECOG performance status is 1. During the first cycle a severe anaphylactic reaction to etoposide occurs.

Which of the following is the best option to replace etoposide in a platinum-based doublet?

A 68-year-old man is diagnosed with non-resectable invasive ductal adenocarcinoma of the right breast (hormone receptor-positive, HER2 negative, Ki67 30%) with lung and bone metastases. His ECOG performance status is 1, he has no comorbidities.

Which is the most appropriate treatment?

A 60-year-old patient has undergone complete resection of an adenocarcinoma of the head of the pancreas. He recovered well from surgery. His only other condition is a longstanding diabetes with grade 3 polyneuropathy. Renal function is normal.

According to the ESMO guidelines, what is the most appropriate further management?

A 32-year-old woman is diagnosed with stage IVB Burkitt lymphoma. Lymphoma affects supra-clavicular, mediastinal (bulk) and inguinal lymph nodes and the liver (diffuse infiltration).
The patient has a long-term partner, with whom she plans to have children. The extension of the disease requires immediate start of highly gonadotoxic treatment (within the next 10 days).

According to the ESMO guidelines, which is the best strategy for fertility preservation?

After complete resection of the primary tumour and of a single liver metastasis in a patient with metastatic colon cancer, stage pT3 pN1 pM1, you receive the pathology report.

Which of the following results is associated with the worst prognosis?

Which of the following drugs is associated with the highest risk for infertility in male patients?

A 45-year-old patient with metastatic melanoma is treated with 3-weekly pembrolizumab. Serum analyses after 6 cycles are shown here:

TSH: 0.043 mIU/l (normal 0.500 – 4.20)

fT4: 30 pmol/l (normal 10-25)

basal cortisol: 0.48 µmol/l (normal 0.15 - 0.70)

The patient has no symptoms. Blood pressure is 130/70 mmHg, heart rate 80/min.

What is the diagnosis and the most appropriate management?

Which of the following treatment options has demonstrated an overall survival benefit in first-line for patients with advanced clear cell kidney cancer, intermediate-risk group according to IMDC (International Metastatic Database Consortium) Risk Model?

A 42-year-old patient was diagnosed with a malignant melanoma on his back (superficial spreading melanoma, Breslow thickness of 1.2 mm, no ulceration). Sentinel node biopsy (left axilla) was negative.

Based on current guidelines, which management is appropriate?

A 62-year-old woman without comorbidities undergoes a colonoscopy due to changes in her bowel habit. The colonoscopy reveals a mass 7 cm from the anal verge. Biopsies confirm an adenocarcinoma, p16 negative, RAS- and BRAF- wild-type. A pelvic MRI classifies the tumour as T4, N2 with enlarged lymph nodes in the perirectal region. A CT scan of the thorax reveals no metastases. Her ECOG performance status is 1.

Which of the following is the best treatment approach for this patient?

Which first-line treatment for advanced hepatocellular carcinoma (HCC) has shown the longest progression-free (PFS) and overall survival (OS) in clinical trials?

A 72-year-old man was newly diagnosed with metastatic prostate cancer and staged as cT3b cN1 cM1 (at least 5 bone metastases: 3 vertebrae, left femur and ribs; 3 lung metastases). Gleason score is 9 (4+5), PSA 378 ng/ml. The patient has no symptoms from the primary tumour.

Which answer is NOT correct?

A 68-year-old woman with metastatic breast cancer (ER/PR positive, HER2 negative) has been treated with letrozole and palbociclib as first-line treatment. Now, she experiences disease progression with multiple bone metastases and 4 liver metastases up to 2 cm in diameter. Her performance status is good (ECOG 1), organ functions are normal. Genomic analyses of tumour tissue reveal a PIK3CA mutation.

What is the most appropriate second-line treatment?

A 64-year-old patient with metastatic bladder cancer has been treated with 6 cycles of cisplatin plus gemcitabine with a partial remission. Performance status is good (ECOG 1) with normal organ functions.

What is the most appropriate next step?

What is the treatment of choice for patients with locally advanced cutaneous squamous cell carcinoma not amenable to local treatment?

A 74-year-old man presents to his family doctor with progressive dysphagia and weight loss (-4kg in the past 6 weeks). He drinks one bottle of wine every day and has a smoking history of 40 pack-years. Medical history: Coronary artery disease with a stent placement 1 year ago and chronic obstructive pulmonary disease. Diagnostic tests (upper endoscopy with biopsies, endoscopic ultrasound and PET-CT) reveal a squamous cell carcinoma in the mid oesophagus, cT3 cN1 M0.

Which is the most appropriate treatment strategy for this patient?

Which is a frequent side effect of apalutamide?

The standard treatment for locally advanced anal cancer is chemoradiotherapy (CRT).

What is true concerning this curative approach?

Fatigue is a frequent complaint of cancer patients, ranging from tiredness to exhaustion.

Which of the following approaches is recommended by the ESMO guidelines?

Which of the following criteria is recommended to assess treatment response in brain tumours?

A 69-year-old man is diagnosed with an adenocarcinoma of the right colon with multiple liver metastases (RAS wildtype, BRAF mutated [V600E], microsatellite-stable [MSS]). Imaging during first-line treatment with FOLFOXIRI plus bevacizumab shows disease progression.

What is the most appropriate second-line treatment?

Bone-modifying agents (BMA) are used to prevent skeletal-related events in patients with bone metastases.

What is true concerning the side effect of hypocalcaemia?

All of the following treatment options have shown an overall survival and progression-free survival benefit when added to androgen-deprivation therapy in patients with newly diagnosed metastatic prostate cancer, EXCEPT:

A 42-year-old man in a very good performance status (PS ECOG 0), noticed a large soft tissue mass (20 cm diameter) on his right thigh. Histology revealed a high-grade pleomorphic sarcoma. The multidisciplinary team judged the tumour as marginally resectable.

What is the most appropriate treatment strategy?

A 38-years-old patient is diagnosed with metastatic, neuroendocrine tumour (NET) of the lung. Ki-67 is 2%. All lesions show avid uptake in somatostatin receptor-based diagnostic imaging. No neuroendocrine symptoms are present.

What is the most appropriate first-line treatment?

A 45-year-old patient, who has been treated for metastatic BRAF-wildtype melanoma for 6 weeks, presents in the emergency department with severe fatigue, elevated temperature (37.9 °C) and abdominal discomfort. On examination he has a performance status ECOG 2, oxygen saturation of 96%, blood pressure 105/70 mmHg, heart rate 102/min and a normal examination of chest and abdomen. Lab values show sodium 132 mmol/L (normal 135-145), potassium 4.6 mmol/L (normal 3.6-4.8), creatinine 67 μmol/l (0.8 mg/dl; < upper limit of normal), CRP 26 mg/L (normal 0-10).

Which diagnostic step will most likely reveal the underlying problem?

A 75-year-old woman presented with breast cancer (BC) 7 years earlier (pT2 N0 M0, estrogen receptor and progesterone receptor-positive, HER2 negative). She was then treated with wide local excision (WLE) followed by adjuvant radiotherapy and an aromatase inhibitor for 5 years. Now, she presents in the clinic with back pain. A CT scan shows axial skeletal metastases in vertebrae and iliac bones.
What is true regarding palliative radiotherapy?

A patient is treated with FOLFOXIRI and bevacizumab for metastatic BRAF-mutated adenocarcinoma of the colon. After the second course the patient loses all his hair within 4 days.

Which drug is most likely the cause?

A 53-year-old patient with metastatic clear cell renal cell carcinoma is treated with nivolumab after prior progression on sunitinib. He comes for his fourth 2-weekly infusion and complains of diarrhoea for the past few days with eight liquid stools in the last 24 hours. His blood pressure is 95/60 mmHg, heart rate 103/min and temperature 36.8˚C. The patient is admitted for i.v. infusion. Stool examination rules out infection and a colonoscopy is planned.

Besides withholding nivolumab treatment, which of the following treatments should be initiated?

A 68-year-old man presented with fatigue, general malaise, generalized lymphadenopathy. Blood counts: Hb 6 mmol/l (100 g/L), leucocytes 80 x 10⁹/L with 96% monoclonal lymphocytes and platelets 90 x 10⁹/L due to a CLL with a TP53 mutation. He has no comorbidity.

Which therapy is the most appropriate for this patient?

A 73-year-old man presented with metastatic recurrence of squamous cell oropharyngeal carcinoma 3 months after completion of definitive radiochemotherapy with cisplatin.

Which of the following is the preferred systemic treatment for this patient?

A 26-year-old woman with a germ cell tumour of the ovary is treated with BEP (bleomycin, etoposide and cisplatin). During and after the first course she suffered from nausea and vomiting despite aprepitant, dexamethasone, ondansetron and metoclopramide.

According to the ESMO Guidelines, which agent should be considered to be added to the anti-emetic schedule?

Management with radiotherapy alone is an option for which type of Hodgkin lymphoma (HL) with Ann-Arbor stage I?

A 49-year-old woman is diagnosed with a neuroendocrine carcinoma grade 3, ki-67 65%, with multiple non-resectable liver metastases and a 1.5 cm lesion in the pancreas. She has no other health problems, and her ECOG performance status is 1.

Which therapy is most appropriate?

Which of the following serum tumour markers is useful to diagnose granulosa cell tumours?