Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

Chapter 20•Cancer of the Gastrointestinal Tract 245

Question 20.2.6. Which of the following statements regarding adjuvant therapy is NOT

true?

A. In patients with resected pancreatic head lesions, survival is superior

with gemcitabine compared with infusional 5FU, when given after

5FU-based chemoradiation.

B. Gemcitabine when compared with observation is associated with pro-

longed disease-free survival and overall survival.

C. 5FU-based chemoradiation followed by chemotherapy with 5FU can

also be considered for adjuvant therapy.

D. In the ESPAC-1 trial, patients who received chemotherapy did better

than those who did not.

Question 20.2.7. A 64-year-old Caucasian woman is diagnosed with locally advanced unre-

sectable pancreatic cancer. She receives 2 months of gemcitabine, and

restaging CT scan of the abdomen and pelvis shows a decrease in the size

of the lesion and her CA19-9 decreases from 854 to 201. What should be

done next?

A. Start 5FU-based chemoradiation

B. Continue gemcitabine chemotherapy for another 2 months, and then

reassess

C. Start gemcitabine-based chemoradiation

D. Add 5FU to her chemotherapy regimen

Question 20.2.8. A 52-year-old Asian woman is evaluated for chronic right upper quad-

rant abdominal pain. Workup leads to diagnosis of pancreatic adenocar-

cinoma with metastasis to the liver. She is extremely anxious and tearful

and wants to do everything possible to prolong her life. Which of the

following regimens has been shown to prolong overall survival compared

with gemcitabine alone?

A. Gemcitabine and oxaliplatin

B. Gemcitabine and capecitabine

C. Gemcitabine and erlotinib

D. Gemcitabine and cisplatin and bevacizumab

E. Gemcitabine and cetuximab

Question 20.2.9. A 45-year-old man is diagnosed with metastatic adenocarcinoma of the

pancreas. Which of the following chemotherapy regimens would be

appropriate first-line treatment choice in this otherwise healthy patient

with normal organ function?

A. Gemcitabine

B. FOLFIRINOX (5FU+leucovorin+irinotecan+oxaliplatin)

C. 5FU with radiation

D. FOLFOX (5FU+leucovorin+oxaliplatin)