Identify your profession: * Physician (In Practice) Physician (Retired) Nurse Practitioner Physician Assistant Resident/Fellow Registered Nurse Advanced Practice Nurse Other Identify your profession: Other Which of the following statements regarding the evaluation of pembrolizumab versus ipilimumab in patients with advanced melanoma is incorrect? * A) Disease-free survival was higher in the pembrolizumab group than in the ipilimumab group. B) Overall survival was higher in the pembrolizumab group than in the ipilimumab group. C) Response rate was higher in the pembrolizumab given every 2 weeks when compared to every 3 weeks D) Rates of treatment related adverse effects of grade 3-5 severity were lower in the pembrolizumab group than in the ipilimumab group Compared to ipilimumab alone, the combination of nivolumab and ipilumumab in treatment-naïve patients with advanced melanoma demonstrated which of the following? * Higher overall response rate (ORR) only in patients with PD-L1 expression (>5% ) Higher progression-free survival (PFS) only in patients with PD-L1 expression Higher overall response rate (ORR) regardless of PD-L1 expression No improvement in PFS or ORR A 40 year old male patient is recently diagnosed with multiple pulmonary nodules on CT scan of the chest performed to rule out pulmonary embolism. Biopsy of one of the nodules is consistent with metastatic melanoma which is noted to be positive for BRAF V600E mutation. He is asymptomatic and has an excellent performance status. Which of the following would you recommend for this patient? * Vemurafenib alone Dabrafenib and Trametinib Dacarbazine Trametinib alone A 55 year old woman with ER/PR-, HER2+ breast cancer is recently diagnosed with metastatic disease involving the liver, lung, and bones. Two years ago, she completed adjuvant therapy with doxorubicin and cyclophosphamide followed by trastuzumab and paclitaxel and then trastuzumab alone. Which of the following options is most likely to yield the longest progression free survival (PFS) and overall survival (OS)? * Lapatinib and capecitabine Trastuzumab, pertuzumab and taxane (docetaxel or paclitaxel) TDM-1 Lapatinib and trastuzumab Trastuzumab and vinorelbine In premenopausal women, the addition of ovarian suppression to adjuvant endocrine therapy has shown which of the following? * Improvement in disease-free survival (DFS) with the addition of ovarian suppression to tamoxifen in the overall population In patient who remained premenopausal after chemotherapy, the addition of ovarian suppression to tamoxifen reduced the risk of breast cancer recurrence compared to tamoxifen alone Addition of exemestane to ovarian suppression did not reduce the risk of recurrence compared to tamoxifen-based therapy None of the above A 77 year old female with diabetes mellitus and CAD undergoes lumpectomy for a 0.8 cm invasive ductal carcinoma, ER/PR +, HER2 3+ by IHC, and 2 sentinel lymph nodes are negative. She is requesting adjuvant therapy with a regimen with relatively fewer side effects. What will you discuss with this woman regarding adjuvant therapy? * Most randomized adjuvant trastuzumab trials did include small, node-negative tumors In a prospective trial, trastuzumab and paclitaxel resulted in an excellent 3 year disease free survival She should strongly consider anthracycline based adjuvant therapy The incidence of symptomatic heart failure with trastuzumab and paclitaxel were significantly higher than reported in other adjuvant trastuzumab trials Which of the following statements regarding the combination of palbociclib and fulvestrant in the treatment of hormone receptor positive, HER2 negative breast cancer is correct? * Patients enrolled in this trial were treatment-naïve The rate of febrile neutropenia was higher in palbociclib+fulvestrant than in the fluvestrant and placebo arm This study included only post- menopausal patients Palbociclib and fulvestrant resulted in similar PFS than fulvestrant alone A 65 year old female has undergone lumpectomy for high-grade ductal carcinoma in situ (DCIS), 3 cms in size. Margins are negative and comedo necrosis is present. She is scheduled to begin radiation therapy. She has read about the side-effects of tamoxifen and wants to find out if there is an alternative to tamoxifen for adjuvant treatment of DCIS. Which of the following statements is true? * Tamoxifen is the only agent tested for adjuvant therapy of DCIS Anastrozole resulted in an improvement in breast-cancer free interval when compared to tamoxifen primarily in women less than 60 years of age Anastrozole resulted in a statistically significant improvement in PFS and OS when compared to tamoxifen There was no difference in the side-effect profile between anastrozole and tamoxifen In the FIRE-3 trial, the addition of cetuximab to FOLFIRI in the front-line treatment of K-RAS wild-type metastatic colorectal cancer demonstrated which of the following? * Better objective response rate compared to FOLFIRI plus bevacizumab OS was higher in the cetuximab group than the bevacizumab group PFS was higher in the cetuximab group than the bevacizumab group Marked OS improvement was noted with bevacizumab in K-RAS wild type patients A 50 year old female with metastatic gastric cancer is being treated with cisplatin, and 5-FU. She has heard about a new drug “ramucirumab” and wants to find out more about this drug in gastric cancer. You tell her that compared to paclitaxel alone, the combination of ramucirumab and paclitaxel resulted in which of the following? * The combination of ramucirumab and paclitaxel resulted in a 37% improvement in PFS compared to paclitaxel alone Ramucirumab and paclitaxel is the new standard of care for frontline therapy of metastatic gastric cancer No OS improvement was seen with the combination arm compared to paclitaxel alone Fatigue, abdomen pain and diarrhea were more common in the paclitaxel alone group while febrile neutropenia was more common in the combination group Hansford et al investigated the age-specific penetrance of gastric and breast cancer in CDH1 mutation carriers. Which of the following about CDH1 mutation carriers is correct? * The cumulative risk of gastric cancer by age 80 years is 50% in men and 70% in women The cumulative risk of breast cancer by age 80 years is less than 20% Testing for CTNNA1 can be considered in hereditary gastric cancer families lacking CDH1 mutation CDH1 mutation carriers are also at a very high risk for thyroid cancers and melanoma Compared to FOLFIRI plus bevacizumab, the combination of FOLFOXIRI plus bevacizumab showed which of the following? * Statistically significant Improvement in PFS, ORR and OS Statistically significant Improvement in PFS, and ORR but not OS Statistically significant Improvement in PFS and OS only in patients with KRAS mutations No improvement in PFS and OS A 50 year old male presents to the oncology clinic to discuss chemoradiation therapy for Stage 3 cancer of the larynx. You discuss radiation therapy with cetuximab or cisplatin. The patient asks about the combination of cetuximab and cisplatin with radiation therapy. Based on the RTOG 0522 trial, you advise the patient that the combination of cetuximab and cisplatin-radiation therapy resulted in: * Similar PFS and OS compared to cisplatin-radiation therapy More frequent interruptions in radiation therapy and higher grade 3/4 radiation mucositis Higher 30-day mortality Patients with p16-positive oropharyngeal carcinoma (OPC), had a better 3 year PFS and OS compared with patients with p16-negative OPC In patients with advanced high/intermediate grade leiomyosarcoma, two randomized phase III trials have shown that compared to dacarbazine: * Eribulin resulted in no statistically significant improvement in OS Treatment emergent adverse events were more common with dacarbazine Trabectedin resulted in a 13% reduction in the risk of death and improved response rate and time to progression None of the above Retrospective analysis of the Gynecologic Oncology Group protocols 114 and 172 evaluating intraperitoneal chemotherapy (IP) in patients with advanced, low volume ovarian cancer demonstrated: * No significant improvement in OS with IP chemotherapy compared with intravenous (IV) chemotherapy Reduction in the risk of progression by 23% Patients with serous histology had worse prognosis than those with mucinous/clear cell histology IP chemotherapy did not improve survival of those with gross residual disease (<1 cms). Primary cytoreductive surgery followed by platinum-based chemotherapy is the mainstay of treatment for advanced disease. In the CHORUS trial neo-adjuvant chemotherapy followed by surgery demonstrated: * Neo-adjuvant chemotherapy was inferior to primary surgery in terms of OS. Grade 3 and 4 post-operative adverse events were more common in the neo-adjuvant chemotherapy group Deaths within 28 days after surgery were more common in the primary surgery group The proportion of patients whose disease was cytoreduced to < 1 cm was not significantly higher in the neo-adjuvant chemotherapy group. A 65 year old female is treated with concurrent chemoradiation therapy with cisplatin for Stage IIIA cervical cancer. Unfortunately 2 years later she presents with multiple pulmonary nodules, biopsy of which confirms metastatic cervical cancer. What would you discuss with this patient regarding palliative chemotherapy? * Cisplatin plus paclitaxel doubled median PFS and OS compared to cisplatin alone OS with Carboplatin -paclitaxel was superior to cisplatin-paclitaxel Among those patients who had not received prior cisplatin-based chemotherapy, median OS was shorter in the carboplatin group than in the cisplatin group The incidence of peripheral neuropathy was higher with cisplatin-paclitaxel than carboplatin-paclitaxel An 18 year old woman presents for consideration of vaccination against human papillomavirus (HPV). She wants a single dose of the vaccine as she is not sure if she would be able to make it for the subsequent doses. Which of the following statements about HPV vaccination is true? * 9 valent HPV vaccine protected against HPV 31, 33, 45, and 58 and antibody response was similar for 6, 11, 16, 18 as quadrivalent vaccine in women 16-26 years of age One-two doses of the HPV-16/18 vaccine provides lesser protection against cervical HPV-16/18 infections as provided by the three-dose schedule 9 valent HPV vaccine provides protection in girls but not boys ages 9-15 years Rucaparib is a potent oral PARP inhibitor. Using tumor genomic analysis, the prospective study identifying ovarian cancer patients most likely to respond to rucaparib showed which of the following? * Similar OS in loss of heterozygosity (LOH)-high tumors as compared with LOH-low tumors PFS was similar in the BRCA-mutated and BRCA-like tumors In BRCA-wild type tumors, BRCA-like subgroup derives higher benefit from rucaparib compared to biomarker negative subgroup ORR was higher in germline thanand somatic BRCA mutated tumors In patients with castrate resistant prostate cancer, the detection of androgen receptor splice variant, AR-7 is associated with which of the following? * AR-7 positive patients had lower PSA response rates but no difference in OS compared to AR-7 negative patients treated with enzalutamide AR-7 negative patients had lower overall survival compared to AR-7 positive patients treated with abiraterone PFS is shorter in AR-7 positive patients treated with enzalutamide compared to AR-7 negative patients None of the above A 55 year old female patient with metastatic adenocarcinoma of the lung is receiving first-line therapy with cisplatin and pemetrexed. She does not have any other medical and has a good performance status. Her tumor is negative for EGFR, ROS1, and ALK. Restaging scans after 4 cycles of treatment show evidence of disease progression. Which of the following treatment would be most appropriate? * Docetaxel Ramucirumab and docetaxel Erlotinib Pemetrexed Best supportive care Concurrent chemoradiotherapy is commonly used for Stage IIIB non-small cell lung cancer. In a retrospective review of Veterans Health Administrative data, compared to carboplatin-paclitaxel with concurrent radiotherapy, which of the following was reported with cisplatin-etoposide (EP) with concurrent radiotherapy? * Superior overall survival More hospitalizations Less infectious complications Improved outcomes in centers where EP was used >50% of the time ROS1 rearrangements has been reported to occur in approximately 1% of patients with NSCLC. Crizotinib has been tested in a Phase I study in patients with ROS1 rearrangements. In the expansion phase of this study, crizotinib was noted to have: * Objective response rate was 72% Median duration of response and PFS was shorter than that seen in ALK1 rearrangements Time to first response was longer than that seen in ALK1 rearrangements None of the above A 55 year old male with no significant past medical history is diagnosed with prostate cancer with biopsy proven widespread metastasis to the spine, pelvis and ribs as well as diffuse intra-abdominal lymphadenopathy. PSA levels are >500 ng/ml. He denies any bony pains or neurological symptoms. His ECOG performance score is 0. Which of the following would be the most appropriate treatment at this time. * Androgen deprivation therapy Observation Androgen deprivation therapy and docetaxel Ketoconazole and steroids Radium-223 The phase 3 study conducted in patients with metastatic prostate cancer who were previously treated with docetaxel and abiraterone and/or enzalutamide, showed that compared to prednisone, cabozantinib was associated with which of the following? * No improvement in PFS or OS Improvement in bone scan response only Improvement in bone scan response, OS and more frequent serious adverse events Improvement in PFS and bone scan response but not in OS Leave this field blank
