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?

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

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?

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

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?

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 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 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 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 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?

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:

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?

Which is a frequent side effect of apalutamide?

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 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 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?

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

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?

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?

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 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 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 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 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 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 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?

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?

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?

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?

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?

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

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 association between PARP inhibitor and specific side effect is wrong?

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

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

Patients with…

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

Which step is unique to CAR-T cell therapy?