ESMO examination trial questions

Type A - Single choice

Select one answer for each question:

- in positively formulated questions select the only correct answer i.e the most appropriate.
- for negatively formulated questions select the only exception, the only incorrect answer that is the answer that appears least appropriate. (The negation is written in bold.)

Associate intravenous standard dose antineoplastic agent with emetogenic potential: Minimal (<10%)
Radically resected cancer and adjuvant treatment; select the most appropriate treatment for PS0 fit patients with Cisplatin and Vinorelbine
Associate the tyrosine kinase inhibitor Sorafenib with the correct starting dose
Sporadic malignancies by sex distribution: associate a cancer with the corresponding male-to-female incidence ratio 2:1
Which germline mutation should you test for in a patient with medullary thyroid cancer and a mother with phaeochromocytoma?
A 60-year-old man presents with generalized massive lymphadenopathy, splenomegaly, polyps in colon containing malignant lymphoma (CD5+, Cyclin D1+, CD20+, IG-M lambda +, CD23-). Which is the most likely diagnosis for this patient?
The functionality of DNA repair machinery as assessed by mismatch repair pathway integrity is useful in case of:
Management with radiotherapy alone is an option for which type of Hodgkin lymphoma (HL) with Ann-Arbor stage I?
PD (Programmed Death) 1-antibody nivolumab is active in second line therapy in squamous cell lung cancer.Which statement is true about this treatment?
A 75-year-old man presented with a high grade unmethylated glioblastoma, WHO PS 2 and a mini mental status examination of 15.Which is the most appropriate treatment strategy for this man?
What is the best treatment for a 78-year-old female patient with metastatic low-grade endometrial stromal sarcoma and 5 pulmonary metastases (bilateral)?
A 23-year-old man with Hodgkin lymphoma stage IIB unfavourable has been treated with ABVD and RT. The PET scan performed 2 weeks after the RT showed persistent activity (Deauville 4) in the mediastinum. The patient has no complaints and is in a good condition. Which is the most appropriate next step in the management of the patient?
A 54-year-old female patient was treated for high-grade serous ovarian cancer, FIGO stage IIIC, with optimal debulking. Then she received 6 cycles of adjuvant carboplatin and dose dense paclitaxel. She was in a complete remission with normal levels of CA-125 and a normal CT scan. 15 months later her general physician finds an elevated CA-125 of 300 U/ml. The patient is asymptomatic. How do you proceed?
A fit 66-year-old man with moderate smoking and alcoholic beverage consumption habits is diagnosed with cT3 cN0 M0 cervical (upper third) esophageal squamous cell carcinoma. The best treatment approach is:
A 54-year-old woman presents with significant weight loss, night sweat, cough and abdominal pain. Her laboratory findings show LDH elevation up to 700 U/l and no relevant impairment of renal or hepatic function. Histologic examination of liver biopsy reveals metastatic melanoma. Molecular analysis shows BRAFV600 mutation. In addition, she suffers from psoriatic arthritis. What is the most appropriate treatment?
Adjuvant chemo-radiation is indicated in the following clinical situation:
A 35-year-old man undergoes a right radical orchiectomy for a pT1 non-seminomatous germ cell tumour. Histo-pathological examination reveals the absence of vascular invasion and a CT scan of the thorax and abdomen shows no abnormalities. However, post-operative alpha-fetoprotein levels are steadily rising.Which of the following options do you recommend in the management of this patient?
A 72-year-old frail man is diagnosed with a prostate cancer showing the following features: Gleason score 3+3=6, clinical stage T1c, PSA 9 ng/ml, 2 positive biopsy cores (out of 6) with a maximum of 30 % cancer. He has a history of coronary artery disease (2 cardiac stents) and non-insulin dependent diabetes mellitus.Which is the management of this patient?
A 64-year-old, otherwise healthy man, had a radical prostato-vesiculectomy in June 2013 because of newly diagnosed prostate cancer. The Gleason score was 4+4=8 and the tumour stage pT2c pN1 (1/17) L1 V1 M0. The patient received no further treatment and PSA was unmeasurable until May 2014. The PSA rose from 0.71 ng/ml in May 2014 to 6.4 in June 2015, a CT scan showed no lymph node or distant metastases.What is the appropriate treatment?
Which is the standard of care in first line treatment of metastatic HER2 positive breast cancer for women in good clinical condition?
A 69-year-old man presented with locally advanced, human papilloma virus positive, inoperable oropharyngeal squamous cell cancer Stage IV A. He is in good clinical condition and has no significant organ impairment. How this patient should be preferentially treated?
A 70-year-old man with WHO PS 1 is diagnosed with metastatic bladder cancer. He wishes to be treated. His creatinine clearance is 35 ml/min.Which is the most suited treatment option for this patient?
Which statement about NSCLC is true?
Concerning the use of targeted agents in metastatic gastric cancer, which statement is correct?
A 65-year-old female patient with stage IV adenocarcinoma of the lung is found to have an exon 19 mutation in the EGF receptor.Which of the following compounds has shown an overall survival benefit compared with chemotherapy containing a platinum doublet in this situation?
A 35-year-old man presents with large mediastinal lymph nodes, liver metastases and high LDH. Histology reveals undifferentiated tumour not further classifiable.What appropriate investigation should be performed?
A 65-year-old woman in good condition presented with a symptomatic chest wall angiosarcoma 12 years after irradiation because of breast cancer. In addition, she received adjuvant chemotherapy with 6 FAC courses. Staging revealed multiple lung metastases in both lungs. Her ejection fraction is 35%.Which palliative therapy is the most appropriate choice for this patient?
A 68-year-old male patient had a pT3, pN1, M0 colon cancer 5 years ago. Following surgery he received adjuvant chemotherapy with FOLFOX.Which subsequent care should he receive?
A 68-year-old man with a family history of prostate cancer (brother at age 60) is diagnosed with prostate cancer: PSA 7.2 ng/ml, Gleason 6 (3+3) involving 50% of a core (T1c), bone scan and CT scan negative for metastatic disease.What procedure do you suggest?
A 52-year-old man presents with severe headache. MRI of the brain reveals a 4 cm mass with surrounding oedema. He undergoes incomplete resection revealing MGMT methylated glioblastoma.Further treatment should include:
A 59-year-old, otherwise healthy woman, is diagnosed with metastatic breast cancer (cT3, N3, M1, G3, ER 80%, PR 50%, HER2 +++ in IHC) with extensive liver and lung metastases. Her ECOG PS is 1, all laboratory values are normal.Her treatment should start with:
A 40-year-old woman presents with a Burkitt lymphoma in the ovaries, bone marrow, breast, and axillary and mesenteric lymph nodes. The lab results show: LDH 2000 U/l, Na 135 mmol/l, K 5.4 mmol/l, Ca 1.9 mmol/l, phosphate 2 mmol/l, uric acid 0.6 mmol/l, creatinine 200 mol/l (1.8 mg/dl), albumin 35 g/l.Which is the most appropriate next step in the management of this patient?
Which of the following drugs blocks the heterodimerization HER-2-HER-3?
Which of the following descriptions best fits the definition of febrile neutropenia according to ESMO guidelines on febrile neutropenia?
The lowest risk for cardiac toxicity is to be expected with which anthracycline and its cumulative dose?
Which statement best describes the benefit of denosumab in patients with solid tumours?
The most common pathology in CUP (Carcinoma of unknown primary site) is:
Most desmoid tumours develop sporadically, but some cases occur in the context of:
A 58-year-old female patient has a history of a recent deep vein thrombosis and is treated with low molecular weight heparin (LMWH). She is admitted to the hospital because of headaches and troubles concentrating. An MRI reveals a large solid mass in the left frontal lobe with extensive perifocal oedema. A biopsy shows glioblastoma.The next step is:
Which statement is true in glioblastoma multiforme?
A 43-year-old man was diagnosed with a T2 N2 M0 nasopharyngeal carcinoma.Which of the following is the standard of care?
Regarding follow-up of breast cancer patients after adjuvant therapy, according to ESMO guidelines, what is recommended?
A 56-year-old patient is diagnosed with visceral recurrence of a triple negative breast cancer. Biochemical study reveals severe hepatic dysfunction (bilirubin 6 mg/dl (102 μmol/l) and SGOT/ASAT 220 units/l). ECOG PS 1. She wishes to be treated.Which is the most suitable treatment option in this case?
A 69-year-old female heavy smoker presents with haemoptoe and hoarseness. A CT scan of the thorax and abdomen shows a centrally located tumour of the left lung with liver metastases. A bronchoscopic biopsy reveals adenocarcinoma. She has a history of poorly controlled hypertension.Which of the following initial chemotherapeutic regimens is recommended?
A patient is undergoing chemotherapy for an adenocarcinoma of the left lung, 50 mm in its longest diameter, with a single liver metastasis 35 mm in its longest diameter. Following 2 cycles of treatment, the primary tumour shrinks down to 40 mm, and the liver metastasis to 30 mm.How would you categorise the response according to RECIST criteria?
Which of the following statements about chronic myeloid leukaemia is correct?
A 75-year-old man receives monochemotherapy with oral capecitabine for colon cancer metastatic to the liver. Twelve days after treatment initiation he develops grade 4 febrile neutropenia and grade 3 diarrhoea and mucositis.Which of the following drug-metabolizing enzymes is most likely to be deficient in this patient?
A 65-year-old man undergoes surgical excision of a right temporal anaplastic oligodendroglioma.Post-operatively, in addition to radiation, which biomarker suggests increased benefit from chemotherapy (i.e. PCV regimen)?
A 56-year-old female smoker presented with cough and haemoptysis. Investigations showed she had a T3N1M1a squamous cell lung cancer.What further information from her tumour sample will likely guide treatment choice?
A 75-year-old man with a lump in the breast was found to have a pT2, N0, M0, ER+/PR+/HER2-negative, grade 1 breast cancer. He was otherwise well with an ECOG performance status of 1.What is the most appropriate next step?
A 26-year-old man, consuming 3 alcoholic beverages/day, presented with lung- and retroperitoneal metastases of a non-seminoma testis. AFP serum level at the start of BEP chemotherapy was 1000 μg/l. Five days after the start of the chemotherapy the serum level was 1300 μg/l.Which is the most likely explanation for this finding?
Which of the following statements regarding gallbladder cancer is correct?
What is the most important endpoint to be specified in a phase I clinical trial exploring a novel agent for cancer treatment?
According to the ESMO Clinical Practice Guidelines which of the following statements about the treatment of localized pancreatic cancer treatment is WRONG?
A sentinel lymph node biopsy is established standard in early breast cancer EXCEPT:
Which of the following agents is NOT an accepted first line systemic treatment for the mentioned sarcomas?
Which of the following statements about malignant pleural mesothelioma (MPM) is NOT true?
Which statement is NOT true for Radium-223 in castrate resistant prostate cancer with bone metastases?
Which agent should NOT be administered to a 24-year-old woman with a T2N1 ER-, PR-, HER2+ breast cancer in her second trimester of pregnancy?
Which of the following antineoplastic drugs is NOT associated with SIADH?
Which of the following second-line treatments should NOT be considered after failure of primary therapy with gemcitabine/carboplatin in a patient with non-squamous NSCLC?
Which of the following side effects is NOT typical for EGFR-TKI treatment?
Hot flashes can be induced by all of the following drugs EXCEPT:
In a 28-year-old healthy man, a palpable tumour is found in the right scapula. A biopsy reveals a small round blue-cell tumour.Which of the following statements is NOT correct?
A 68-year-old woman is diagnosed with gastric adenocarcinoma, diffuse type. She is otherwise healthy. The endosonography reveals a tumour (T3, N0).Which of the following is NOT a treatment option?
The following treatments have been shown to reduce the incidence of breast cancer in women at high risk with the EXCEPTION of:
Which of the following is NOT considered a potential aetiology for mesothelioma development?
A 70-year-old woman presented to her primary care physician for a yearly check-up. Physical examination revealed lymph node enlargement and splenomegaly. She was diagnosed with B-CLL, stage Binet B.Which of the following is NOT an indication for initiation of therapy?
Which of the following statements applies to glioblastoma?
A 45-year-old woman without any comorbidities, performance status 1, with a KRAS mutated colonic cancer presents with multiple lung, liver and lymph node metastases 2 years after adjuvant chemotherapy with capecitabine and oxaliplatin. Which systemic treatment is recommended?
A 51-year-old, otherwise healthy woman is diagnosed with a T4d invasive ductal adenocarcinoma of the right breast, G3, ER/PR 80%. There is clinical evidence of axillary lymph node involvement. PET/CT shows M0. What is the correct treatment?
A 61-year-old woman, former smoker with 20 pack years, is diagnosed with a T2 N1 M0 lung cancer. EBUS (endoscopic bronchial ultrasound) reveals small cell cytology. You order concomitant chemoradiation and start with chemotherapy immediately. After 2 cycles, before starting radiotherapy, restaging shows stable disease (10% regression). What is the appropriate next step?
A 62-year-old woman presents with 8kg weight loss over 1 year and a persistent cough over 3 months. She has a history of type II diabetes and hypertension, both well controlled. A thoraco-abdominal CT reveals multiple pulmonary nodules, all smaller than 1cm. In addition, there are enlarged retroperitoneal lymph nodes, some lytic vertebral bone lesions and a cervical mass extending to the left pelvic wall. The biopsy of the cervical mass shows poorly differentiated squamous cell cancer. Her performance status is 1 and she wishes the most active treatment. What is the most adequate treatment?
A 30-year-old non-smoking-man in good condition presents with lymph node, lung and liver metastases of TTF-1 and CK7+ adenocarcinoma. Staging procedures, including a PET scan, revealed no primary tumour. Which is the most appropriate next step?
A 70-year-old woman, performance status 1, presents with severe vaginal bleeding because of a stage IVB clear cell endometrial grade III carcinoma with multiple lymph node, peritoneal and lung metastases. Which is the most appropriate treatment in this case?
Peptide receptor radionuclide therapy (PRRT) activity in neuroendocrine tumours is dependent on:
A 70-year-old female patient is diagnosed with breast cancer (adenocarcinoma NST). The diagnostic workup reveals a cT3 (multicentric) cN1 M0 tumour with ER 15% positive, PR 2%, HER-2 negative, the Ki67 proliferation marker is 31%. The patient has no concomitant diseases. What is the correct management?
A 50-year-old woman is treated with nivolumab because of metastatic lung cancer. She presented with dyspneoea due to pneumonitis grade II. No pathogen was cultured. Which is the most appropriate approach after stopping nivolumab?
A 52-year-old patient with breast cancer receives the first cycle of an adjuvant (anthracyclin based) chemotherapy, and seven days later experiences a fever of 38.7 °C. Laboratory tests are obtained, and her absolute neutrophil count is 0.3 x 109/L. She has no focal symptoms. The MASCC (multidisciplinary association of supportive care in cancer) score shows high risk. An appropriate strategy could consist of which of the following options?
Which cytostatic drug has a severe interaction with aprepitant?
A 79-year-old frail man presented with a history of diarrhoea, acute diverticulitis and perforation. At laparotomy, an unresectable tumour in the caecum and liver metastases in both lobes were detected. Histology showed a well differentiated neuro-endocrine tumour (NET). The patient recovered from the complications of the diverticulitis. Which is the most appropriate management of the patient with regard to the NET?
A 45-year-old patient with a history of hypertension presented with a large (12cm) gastric mass. A thoraco-abdominal CT scan reveals no other lesions. Biopsy shows a GIST with a high mitotic count. In the multidisciplinary tumour-board surgery is considered feasible but would include removal of the spleen and pancreas in order to obtain an R0 resection. What is the best way to proceed?
Which statement concerning high-grade osteosarcomas is correct?
An 82-year-old patient has metastatic pancreatic cancer with severe abdominal pain, non-responsive to paracetamol. His liver function is normal, the creatinine-clearance is 28ml/min. What is the best pain management?
A patient with metastatic castration resistant prostate cancer and newly diagnosed bone metastasis starts treatment with abiraterone acetate and denosumab. Eight weeks later he presents with dizziness and muscle cramps. The most likely diagnosis is:
Which is the standard duration of adjuvant trastuzumab therapy in HER2- positive early breast cancer patients?
A 55-year-old woman in good clinical condition presents with two liver metastases of about 2cm in size. Further examination does not reveal other lesions. She had a history of ER positive, PR positive and HER2 negative breast cancer and had been treated with adjuvant chemotherapy (anthracycline, taxane), radiotherapy and adjuvant endocrine therapy with tamoxifen until 2 years ago. How would you proceed with this patient?
Regarding metastatic breast cancer, for which of the following patients, current evidence supports the use of platinum-based chemotherapy in second line?
A 37-year-old man underwent a palliative right-sided hemicolectomy because of a stenotic colon ascendens carcinoma with extensive peritoneal metastases. Histology revealed adenocarcinoma of the colon G3, biomarker analysis showed KRAS and NRAS wildtype and a BRAF V600E mutation. According to tumour board decision a palliative systemic treatment is recommended for this patient without relevant comorbidities. Which is the most effective first line protocol in terms of overall survival?
What is true of a traditional phase I trial?
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?
What is the standard first-line chemotherapy regimen for a patient with metastatic cholangiocarcinoma?
Which is the target of Ipilimumab?
A 45-year-old woman presented with retroperitoneal and mediastinal lymphadenopathy. Histologically squamous cell carcinoma was diagnosed. No primary tumour was found by CT and MR scanning, endoscopy, bronchoscopy, ENT-endoscopy and gynaecologic examination. Further tissue examination revealed positivity for human papilloma virus. Which is the most probable diagnosis?
A 64-year-old man in good performance status and otherwise healthy state presents with macrohematuria. An abdominal ultrasound reveals a 10cm mass in the right kidney. Additional CT staging shows multiple 1cm lung metastases. The next step should be:
Which of the following statements with regard to primary brain tumours is appropriate?
Which is the most common epithelial ovarian cancer subtype?
A patient with adenocarcinoma of the lung with a known EGFR exon 19 mutation has been treated with an EGFR TKI for 12 months. Staging CT shows progression of the primary and new liver metastases. Which is the most likely cause of progression in this patient?
A 75-year-old man presents with splenomegaly, enlarged lymph nodes in axillae, and the para-aortic region. Blood counts: Hb 6 mmol/l (10 g/l), platelets 95 x 109/l, leucocytes 24 x 109/l with 69% monoclonal lymphocytes, CD20+, CD5+, CD23-, Ig-M+, Ig-D+. Lymph node biopsy: monoclonal lymphocytes, Cyclin D1+. What is the most likely diagnosis?
A fit 20-year-old man has a primitive neuro-ectodermal tumour (PNET, Ewing tumour group) of the chest wall without metastases. Which treatment should the patient receive?
Which cancer's incidence is NOT elevated in BRCA-1/2 mutation carriers?
Metastatic melanoma harbouring a BRAFV600-mutation can be treated with a combination of BRAF- and MEK- inhibitors. Which statement concerning this combination therapy in comparison to BRAF-inhibitors monotherapy is NOT true?
The international workshop on chronic lymphocytic leukaemia defined criteria for 'active disease', identifying patients for whom therapy is indicated. Which parameter is NOT an indication for treatment?
Which statement about peripheral neuropathy (PN) secondary to chemotherapy is NOT true?
A 58-year-old man was diagnosed with a metastatic gastro-oesophageal junction cancer (adenocarcinoma G3, HER2 negative). He received a platinum - fluoropyrimidine doublet chemotherapy as first-line treatment. Tumour progression was observed after 4 cycles. Which one is NOT an appropriate monotherapy option?
Which of the following skin toxicities is NOT typically observed during single-agent treatment with an anti-EGFR monoclonal antibody?

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