Devita, Hellman, and Rosenberg's Cancer

LWBK1006-18 LWW-Govindan-Review November 24, 2011 11:24

206 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 18.4. A 65-year-old man with a 40 pack-year history of smoking, presents to

the emergency room with shortness of breath. Chest radiograph demon-

strates a left lower lobe mass and left pleural effusion. CT reveals a 3-cm

left lower lobe mass, left hilar fullness, and a moderate left pleural effu-

sion. Biopsy of the mass and thoracentesis are both positive for adeno-

carcinoma. Staging studies do not reveal any distant metastases. Which

of the following is the next best step in his management?

A. Referral to a thoracic surgeon

B. Radiation to the chest

C. Concurrent chemotherapy and radiation

D. Platinum-based doublet therapy

Question 18.5. A 66-year-old man, with a 30 pack-year history of smoking, presents

to your office for consultation regarding chemotherapy options for

metastatic NSCLC, squamous histology. He has no significant medical

problems and his performance status (PS) is 1. Laboratory studies reveal

normal blood counts, liver enzymes, and kidney function. Which of the

following treatment regimens would you recommend?

A. Cisplatin and pemetrexed

B. Carboplatin, paclitaxel, and bevacizumab

C. Carboplatin and paclitaxel

D. Carboplatin and erlotinib

Question 18.6. A 55-year-old Asian woman, who is a never smoker, completed four cycles

of front-line carboplatin and paclitaxel, for metastatic NSCLC. Imaging

studies done after completion of therapy show stable disease. She is very

active, and has continued to work as a nurse throughout her treatment.

Her PS is 0 and she has tolerated the treatment well, other than grade

I neuropathy. Her tumor EGFR status is wild type. She wants “the best

treatment possible” and desires further treatment. What would you rec-

ommend?

A. Treatment break, erlotinib at the time of disease progression

B. Stopping carboplatin, continuing paclitaxel till disease progression

C. Continuing carboplatin and paclitaxel for four additional cycles

D. Pemetrexed maintenance therapy

Question 18.7. Which of the following statements is INCORRECT regarding the role of

prophylactic cranial irradiation (PCI) in lung cancer?

A. PCI reduces the incidence of brain metastases in limited-stage and

extensive-stage small cell lung cancer (SCLC).

B. PCI improves survival in patients with extensive-stage SCLC, who

respond to front-line chemotherapy.

C. PCI improves survival in patients with early-stage NSCLC.

D. Patients who receive PCI therapy have long-term cognitive defects.