Devita, Hellman, and Rosenberg's Cancer

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

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

Question 18.12. A 60-year-old man with a 45 pack-year history of smoking, presents with

central chest pain. Chest x-ray reveals a right upper lobe mass. CT scan of

the chest demonstrates a 4-cm right upper lobe lung mass, with right hilar

and multiple ipsilateral enlarged mediastinal lymph nodes. Bronchoscopy

and biopsy of the mass reveals NSCLC. PET scan demonstrates increased

FDG-uptake in the lung mass, right hilar and mediastinal lymph nodes,

but no other site of metastatic disease. CT of the abdomen and brain MRI

are within normal limits. Mediastinoscopy and biopsy reveals NSCLC.

His cancer is staged as T2a N2 M0, stage IIIB NSCLC. His PS is 1,

and he is otherwise in good health. Which of the following is the best

management for this patient?

A. Definitive radiation to the chest

B. Radiation to the chest, followed by platinum-based chemotherapy

C. Concurrent radiation to the chest and platinum-based chemotherapy

D. Platinum-based chemotherapy

Question 18.13. Which of the following statements is INCORRECT regarding large cell

neuroendocrine tumors (LCNEC)?

A. Paraneoplastic syndromes are commonly associated with LNEC.

B. Like SCLC, LCNEC have an aggressive natural history and propen-

sity to metastasize.

C. LCNEC are treated in the same manner as NSCLC, with the same

treatment algorithm, stage for stage.

D. LCNEC are less chemosensitive than SCLC.

Question 18.14. A 45-year-old Asian woman, who is a never smoker, presents to your

office for consultation regarding systemic therapy for metastatic adeno-

carcinoma of the lung. Her tumor has activating EGFR mutation and she

inquires regarding the use of erlotinib in the first-line setting. Which of the

following statements is INCORRECT regarding the use of EGFR TKIs

in previously untreated patients with NSCLC?

A. In patients with activating EGFR mutations, initial therapy with an

EGFR inhibitor results in longer time to progression compared with

chemotherapy.

B. In patients with activating EGFR mutations, initial therapy with

either an EGFR TKI or with chemotherapy results in similar over-

all survival.

C. Front-line EGFR TKIs are less effective than chemotherapy in patients

with unknown EGFR status, or wild-type EGFR.

D. Erlotinib should be combined with chemotherapy in patients with

activating EGFR mutation-positive tumors.