ESMO EXAMINATION – Answers to trial questions

Last update 5/10/2021

Type A – Single choice

The correct answers are marked in bold

A1
A 45-year-old patient, who has been treated for metastatic BRAF-wildtype melanoma for 6 weeks, presents in the emergency
department with severe fatigue, elevated temperature (37.9 °C) and abdominal discomfort. On examination he has a
performance status ECOG 2, oxygen saturation of 96 %, blood pressure 105/70 mmHg, heart rate 102/min and a normal
examination of chest and abdomen. Lab values show sodium 132 mmol/L (normal 135-145), potassium 4.6 mmol/L (normal
3.6-4.8), creatinine 67 μmol/l (0.8 mg/dl; < upper limit of normal),
CRP 26 mg/L (normal 0-10).
Which diagnostic step will most likely reveal the underlying problem?
A) ACTH stimulation test

B) Blood cultures

C) CT scan of the abdomen

D) Electrocardiogram and serum troponin

E) Serum TSH

A2
While you are on emergency duty, a 57-year-old patient, who started treatment for metastatic colorectal cancer three weeks
ago, presents with an itching rash (see picture). As recommended, he used daily moisturizing cream and protected the skin
from the sun. However, he forgot to take the daily pills that your colleague prescribed.
Which „pills“is he most likely referring to?
 A) Capecitabine

B) Ciprofloxacin

C) Doxycycline

D) Magnesium/calcium tablets

E) Vitamin B complex

A3

A 34-year-old woman, desiring future fertility, presents with newly diagnosed breast cancer (cT3 N+ M0, ER-positive, PR-
positive, HER2-negative). She’s scheduled to be treated with neoadjuvant anthracycline- and taxane-based chemotherapy,
breast surgery, adjuvant radiotherapy and endocrine therapy.
What is important regarding fertility?
A) An LHRH agonist during chemotherapy increases post-chemo pregnancy rates

B) Her age does not influence a future pregnancy

C) Initiating adjuvant endocrine therapy can safely be postponed for pregnancy

D) Ovarian stimulation with tamoxifen or an aromatase inhibitor for oocyte cryopreservation is recommended before
starting chemotherapy

E) Resuming menses is a reliable indicator for preserved fertility

A4
Regarding the metabolism of the 5-fluorouracil, which statement is correct?
A) Assessment of DPYD mutations can predict 5-FU toxicity

B) Dihydropyrimidine dehydrogenase (DPD) is a key enzyme in the metabolic catabolism of 5-FU but not of capecitabine

C) DPD activity is not a predictive biomarker of potential toxicity when using 5-FU

D) In patients with complete DPD deficiency, fluoropyrimidines could be used with an adapted posology

E) Patients with known partial DPD deficiency do not benefit from dose adaptation of their 5-FU therapy

A5
You see a new patient with metastatic cancer of unknown primary origin. Immunohistochemical work-up shows a CK7- and
CK 20-negative tumour.
Which of the following is the most probable origin?
A) Colorectal cancer

B) Merkel cell cancer

C) Ovarian cancer

D) Renal cell cancer

E) Urothelial cancer
A6
An 82-year-old woman with metastatic HER2-positive, hormone receptor-negative breast cancer suffers from dyspnoea on
exertion from pulmonary metastases. Concomitant diseases are well-controlled diabetes mellitus and arterial hypertension.
Cardiac, renal and hepatic function are normal for her age. ECOG performance status is 1.
Which is the best management for this patient?
A) Best supportive care

B) Trastuzumab, pertuzumab and lapatinib

C) Trastuzumab and fulvestrant

D) Trastuzumab and capecitabine

E) Trastuzumab and epirubicin

A7
An 82-year-old patient with metastatic castration-resistant prostate cancer has progressive disease upon first-line treatment
with enzalutamide. CT scan reveals new bone metastases, multiple enlarged lymph nodes and suspicion of a liver metastasis.
He has ischemic heart disease (with a left ventricular ejection fraction of 35 %), diabetes type II with a chronic diabetic foot
ulcer, chronic renal insufficiency (glomerular filtration rate of 40 ml/min), and minor cognitive impairment. He needs to rest
most of the day.
Which of the following treatment strategies is most appropriate?
A) Abiraterone acetate and prednisone

B) Best supportive care

C) Cabazitaxel

D) Docetaxel

E) Radium 223

A8
A 62-year-old patient with metastatic renal cell carcinoma was treated with third-line cabozantinib for 6 weeks and presented
to the emergency department with confusion, polydipsia and constipation. He uses oxycodone 30 mg twice daily for painful
bone metastases.
Blood pressure was 102/73 mmHg, heart rate 96/min, temperature 36.5˚ Celsius. Blood analyses show a haemoglobin of
89 g/L (normal 120-160), leucocytes 23 x109/L (normal 3.5-10), creatinine 126 µmol/L (normal 50-105), GFR 51 ml/min,
C-reactive protein 112 mg/L (normal <10), albumin 27 g/L (normal 35-50) and
calcium 3.10 mmol/L (normal 2.28-2.65).
Which of the following options is the most likely diagnosis and proposed treatment?
A) Anaemia: Blood transfusion is indicated

B) Infection: Broad-spectrum antibiotics are indicated

C) Hypercalcaemia: Isotonic saline infusion and bisphosphonates are indicated

D) Side effect from cabozantinib: Treatment should be interrupted

E) Side effect from oxycodone: Naloxone is indicated

A9
In patients with metastatic cancer, what is correct about pain management?
A) Analgesics for chronic pain should be prescribed on an ‘as required’ schedule

B) Fentanyl and buprenorphine are the safest opioids in patients with severely impaired renal function

C) In patients with recurrent bone pain re-irradiation should not be offered

D) Intravenous administration is the first-choice alternative for patients unable to receive oral or transdermal opioids

E) The opioid of first choice for moderate to severe cancer pain is fentanyl

A10
A 56-year-old man with metastatic urothelial carcinoma shows tumour progression under first-line chemotherapy with
platinum/gemcitabine.
Which of the following drugs improves survival in second-line treatment?
A) Atezolizumab

B) Methotrexate

C) Paclitaxel

D) Pembrolizumab

E) Vinorelbine
A11
An 82-year-old, otherwise healthy and very fit patient had an amputation of the 5th finger of the left hand because of a
melanoma 2 years ago. Histology showed pT3 pN0 (0/1) sn, Breslow 3.3 mm, BRAF wildtype. Now he is diagnosed with
symptomatic brain metastases; and asymptomatic soft tissue and lung metastases. He experiences resolution of the
neurological symptoms with
4 mg dexamethasone/day.
Which treatment is recommended?

A) Brain surgery followed by immunotherapy

B) Brain surgery followed by radiotherapy

C) Immediate immunotherapy

D) Stereotactic radiotherapy followed by immunotherapy

E) Whole-brain radiotherapy followed by immunotherapy

A12
Which of the following criteria is required for a complete remission (CR) according to the International Myeloma Working
Group (IMWG) in multiple myeloma?
A) >90% reduction of soft tissue manifestation

B) Absence of clonal plasma cells by Next Generation Sequencing (NGS) on bone marrow aspirate

C) Negative immunofixation on serum and urine

D) Normalization of free light chain (FLC)-ratio

E) Plasma cells <10% on bone marrow aspirate

A13
A 70-year-old man was diagnosed with a lung cancer of 8 cm diameter and infiltration of the right N. laryngeus recurrens.
PET-CT showed multiple enlarged hypermetabolic bilateral mediastinal lymph nodes but no distant metastasis. Histological
and immunohistological evaluation revealed adenocarcinoma with
PD-L1 expression of 55 % in the tumour tissue. The patient has a good performance status (ECOG 1) and normal renal
function.
Which is the optimal approach for this patient?
A) Cisplatin-based induction chemotherapy followed by sequential radiotherapy and immunotherapy with
pembrolizumab for one year

B) Cisplatin-based neoadjuvant chemotherapy followed by surgery, adjuvant radiotherapy and maintenance

immunotherapy with durvalumab

C) Definitive concurrent cisplatin-based chemo-/radiotherapy followed by one year of immunotherapy with durvalumab

D) Palliative immuno-/chemotherapy with pembrolizumab and carboplatin/pemetrexed for 4-6 cycles followed by
maintenance immunotherapy with durvalumab

E) Palliative immunotherapy with pembrolizumab

A14
A 75-year-old man with a 30-year smoking history is diagnosed with metastatic adenocarcinoma of the lung. Performance
status is ECOG 1.
Molecular analysis reveals no driver mutation or translocation in EGFR, ALK, ROS-1 and BRAF genes. PD-L1 expression is 80 %.
Which is the most appropriate treatment?
A) Combination therapy with carboplatin and paclitaxel

B) Combination therapy with cisplatin and pemetrexed

C) Combination therapy with cisplatin, pemetrexed and nivolumab

D) Monotherapy with pembrolizumab

E) Monotherapy with pemetrexed

A15
Which mutated gene is associated with HNPCC (hereditary non-polyposis colon cancer)-syndrome?
A) BRCA1

B) K-RAS

C) MLH1

D) Rb

E) TP53

A16
You are going to manage a 42-year-old man who underwent R0 resection for early stage pancreatic ductal adenocarcinoma.
He is otherwise healthy with ECOG performance status 1 and good organ functions.
What is the most appropriate adjuvant treatment?
A) 5-FU plus nano-liposomal irinotecan

B) Gemcitabine plus capecitabine

C) Gemcitabine plus erlotinib

D) mFOLFIRINOX

E) Nab-paclitaxel and gemcitabine

A17
Which statement regarding Temozolomide is correct?
A) It increases the risk of opportunistic infections

B) It is a 5-fluorouracil analogue

C) It is administered as monotherapy as a one week on, one week off scheme

D) It is less active in glioblastoma with methylated MGMT promoter

E) It prolongs QTc-time in ECG

A18
A 63-year-old woman is diagnosed with a high-grade, serous adenocarcinoma of the ovary, FIGO stage IIIC. She received
optimal debulking and recovered well from surgery. She has no concomitant diseases. ECOG performance status is 1. She is a
known carrier of a BRCA-1 mutation.
What is the best management for this patient to prevent progression?
A) Hyperthermic intraperitoneal chemotherapy

B) Regular follow-up and monitor CA-125 in the serum

C) Six cycles of carboplatin/paclitaxel

D) Six cycles of carboplatin/paclitaxel followed by bevacizumab maintenance

E) Six cycles of carboplatin/paclitaxel followed by olaparib maintenance

A19
A 60-year-old man was diagnosed with a tumour in the rectum (5.5 cm in diameter), 2 mm from the anal sphincter. Biopsy
revealed a mesenchymal tumour, spindle cell type, DOG1 and CD117 positive. Staging with PET/CT showed no evidence of
metastatic lesions but a high FDG uptake of the rectal mass.
What is the most appropriate treatment strategy?
A) Neoadjuvant imatinib, surgery and adjuvant imatinib

B) Neoadjuvant sunitinib, surgery and adjuvant sunitinib

C) Surgery (rectal amputation)

D) Surgery and adjuvant imatinib

E) Surgery and adjuvant sunitinib

A20
A 67-year-old woman has symptomatic progression of her metastatic liposarcoma after treatment with doxorubicin.
What is the preferred second-line treatment?

A) Ifosfamide

B) Gemcitabine and dacarbazine

C) Gemcitabine and docetaxel

D) Olaratumab

E) Trabectedin

A21
A 57-year-old patient was diagnosed with a cT3 N0, ER positive (25 %), PR negative (0 %), HER2-positive breast cancer. Staging
evaluation showed 6 bone metastases, confirmed by histopathologic examination. The patient is asymptomatic.
For which first-line treatment improved overall survival was demonstrated?
A) Anastrozol plus palbociclib

B) Capecitabine plus trastuzumab

C) Docetaxel plus trastuzumab plus pertuzumab

D) Lapatinib plus trastuzumab

E) Trastuzumab emtansine (TDM-1)

A22
A 68-year-old man is newly diagnosed with a prostate cancer showing the following features: Cancer in 6 of 12 core biopsies,
bilaterally, Gleason score 4+5=9,
PSA 10.4 ng/dl, CT and bone scan without evidence of lymphadenopathy or distal metastases.
What is the most appropriate treatment plan?
A) Active surveillance with yearly biopsies and PSA assessment

B) Brachytherapy

C) External beam radiotherapy and short-term androgen-deprivation therapy (ADT)

D) External beam radiotherapy and long-term ADT

E) Radical prostatectomy
A23
Based on randomised controlled trials, which adjuvant therapy is recommended for a healthy patient with completely
resected stage III, BRAF mutant (V600E) malignant melanoma?
A) Dabrafenib and trametinib for 12 months

B) Dacarbazine for 6 months

C) Interferon gamma for 24 months

D) Ipilimumab for 4 months

E) Nivolumab for 24 months

A24
A 59-year-old woman presents with dizziness, disorientation, imbalance and large cervical and axillary lymphnodes up to
7 cm. Laboratory analyses show abnormalities in leucocytes 34 x109/L (normal 3.5-10), haemoglobin 91 g/L (normal 120-160),
platelets 66 x109/L (normal 150-450), total protein 112 g/L (normal 64-83) and
IgM-concentration 64.5 g/L.
The neurological symptoms are most likely due to:
A) Anaemia

B) Cerebellar lymphoma involvement

C) Cerebral haemorrhage

D) Hyperviscosity

E) Meningeosis lymphomatosa

A25
A 43-year-old patient is newly diagnosed with HIV infection. In addition, a stage IIA diffuse large B-cell lymphoma (DLBCL) is
diagnosed.
What is correct?
A) Antiretroviral therapy should be initiated

B) Chemotherapy doses should be reduced by 25 %

C) Involved field radiotherapy should be given

D) No treatment for the DLBCL is necessary, if full immune-reconstitution is achieved

E) Primary G-CSF prophylaxis with R-CHOP 21 is indicated

A26
A patient is treated with FOLFOXIRI plus 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) 5-fluorouracil

B) Bevacizumab

C) Ifosfamide

D) Irinotecan

E) Oxaliplatin
A27
A 65-year-old patient with jaundice is diagnosed with adenocarcinoma of the pancreas. CT scan shows no distant metastases.
Infiltration of which structure is most critical in limiting resectability?
A) Ampulla vateri

B) Duodenum

C) Portal vein

D) Splenic artery

E) Superior mesenteric artery

A28
A 60-year-old man presented with a left renal mass. Renal biopsy showed clear cell carcinoma. A CT scan revealed lung and
bone metastases. Blood test were normal, except for a haemoglobin of 97 g/L (normal 120-160).
What is the best approach for this patient?
A) Atezolizumab-bevacizumab

B) Cytoreductive nephrectomy followed by sunitinib

C) Cytoreductive nephrectomy followed by ipilimumab-nivolumab

D) Ipilimumab-nivolumab

E) Sunitinib

A29
Which of the following factors most prominently increases the fracture risk in postmenopausal women with breast cancer?
A) 25 pack-years of smoking

B) Bone mineral density (BMD) T-score of ≤ 1.5

C) High body mass index (BMI) (> 30 kg/m2)

D) History of oral corticosteroid use for 2 months

E) Tamoxifen treatment

A30
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 8 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 rule out infection and a colonoscopy is planned.
Besides withholding nivolumab treatment, which of the following treatments should be initiated?
A) Antibiotics

B) Infliximab 5 mg/kg

C) Loperamide

D) (Methyl)prednisolone 2 mg/kg

E) Mycophenolate mofetil 500 mg 2x/day

A31
A 67-year-old man with metastatic low-grade small bowel neuroendocrine tumour and carcinoid syndrome receives
treatment with octreotide LAR 30 mg every 4 weeks. CT scan and radionuclide examination demonstrate progression of liver
and retroperitoneal metastases.
Which of the following treatments has been shown to significantly improve progression-free survival in such patients?
A) 177-Lutetium-dotatoc

B) High dose octreotide

C) Lanreotide

D) Sunitinib

E) Temozolomide, capecitabine

A32
A premenopausal 45-year-old woman underwent breast-sparing surgery with sentinel lymph node biopsy. A grade 1 invasive
ductal carcinoma of 7 mm diameter and negative sentinel lymph nodes were found, ER positive/PR positive, HER2-negative.
Which of the following approaches is most appropriate?
A) Adjuvant aromatase inhibitor and ovarian suppression

B) Adjuvant fulvestrant

C) Adjuvant raloxifene

D) Adjuvant tamoxifen

E) Follow-up only

A33
Which of the following therapies has the best outcome in a 45-year-old patient with chronic HCV liver cirrhosis, Child-Pugh
class A, and hepatocellular carcinoma (one nodule of 2 cm in each lobe; T2 N0 M0)?
A) Chemo-embolization

B) Liver transplantation

C) Nivolumab

D) Radio-embolization

E) Sorafenib

A34
What statement is correct about soft-tissue sarcoma (STS)?
A) Anthracycline and trabectedin are the backbone of systemic therapy in patients with metastatic STS

B) CT chest is mandatory for staging

C) Imatinib is standard of care in leiomyosarcoma

D) Primary site of metastases in STS are the lymph nodes

E) Risk of relapse in high-risk STS is highest in years 5-6 after initial diagnosis
A35
A 65-year-old heavy smoker was diagnosed with a pathological vertebral fracture. He complains about shortness of breath
when tying his shoes, swollen neck and frequent headaches. A fine-needle aspiration of a supraclavicular lymph node reveals
small cell cancer cytology.
What is the next procedure?
A) Biopsy of the supraclavicular lymph node

B) Concomitant chemoradiotherapy

C) Platinum-based palliative chemotherapy

D) Radiotherapy

E) Stent in superior vena cava

A36
A 53-year-old, otherwise healthy patient was diagnosed with a rectal cancer, 15 cm above the anal verge. CT and MRI staging
showed T3 N1 M0, negative circumferential resection margin (CRM).
What is the correct treatment strategy?
A) Neoadjuvant radiotherapy (5x5Gy) followed by surgery

B) Neoadjuvant chemoradiotherapy followed by surgery and adjuvant chemotherapy

C) Neoadjuvant chemoradiotherapy followed by surgery

D) Surgery followed by adjuvant chemotherapy

E) Surgery followed by adjuvant chemoradiotherapy

A37
A 51-year-old otherwise healthy woman presents with a pelvic mass. Surgical staging and optimal debulking reveals a 2 cm
epithelial serous ovarian tumour of low malignant potential in the right ovary, with capsule rupture and multiple peritoneal
implants without evidence of invasion.
What is the adequate management?
A) Observation

B) Six cycles of carboplatin/paclitaxel

C) Six cycles of carboplatin/paclitaxel and bevacizumab followed by 6 months of bevacizumab maintenance therapy

D) Six cycles of intraperitoneal cisplatin and i.v. paclitaxel

E) Three cycles of carboplatin/paclitaxel

A38
Which result in a randomized trial proves that a cancer screening test "saves lives"?
A) 5-year survival rates in cancer patients detected by screening are better than in cancer patients from the unscreened
population

B) More cancers are detected in the screened population than in the unscreened population

C) Mortality rates are lower among screened persons vs. unscreened persons

D) Screening detects cancer at an earlier stage

A39
A biomarker is a measurement variable that is associated with disease outcome.
The following graphs show a biomarker that is:

A) Both prognostic and predictive

B) Neither prognostic nor predictive

C) Predictive only

D) Prognostic only
A40
Which of the following targeted therapies represents standard of care for patients with metastatic or locally advanced basal
cell carcinoma that is not amenable to treatment with surgery or radiation therapy?

A) Dabrafenib

B) Dasatinib

C) Erlotinib

D) Trametinib

E) Vismodegib

A41
Which of the following statements applies to glioblastoma?
A) Bevacizumab in combination with radiotherapy and temozolomide increases overall survival as frontline therapy

B) Bevacizumab combined with chemotherapy increases overall survival in recurrent disease

C) Lomustine (CCNU) is an option in recurrent disease

D) MGMT promoter methylation is not a predictive marker for benefit from alkylating chemotherapy

E) Checkpoints inhibitors prolong PFS in recurrent disease

A42

A 45-year-old woman without any comorbidities, performance status 1, with a KRAS mutated colonic cancer presents with
multiple lung, liver and lymph node metastases 2 years after adjuvant chemotherapy with capecitabine and oxaliplatin.
Which systemic treatment is recommended?
A) Panitumumab, 5-FU, irinotecan

B) Cetuximab and 5-FU, irinotecan

C) Nivolumab

D) Capecitabine, oxaliplatin and bevacizumab

E) Regorafinib

A43

A 51-year-old, otherwise healthy woman is diagnosed with a T4d invasive ductal adenocarcinoma of the right breast, G3,
ER/PR 80%. There is clinical evidence of axillary lymph node involvement. PET/CT shows M0.
What is the correct treatment?
A) Neoadjuvant chemotherapy and breast conserving surgery (BCS)

B) BCS and adjuvant chemotherapy

C) Neoadjuvant chemotherapy and mastectomy

D) Mastectomy and adjuvant chemotherapy

E) Neoadjuvant hormonal therapy and mastectomy

A44

A 61-year-old woman, former smoker with 20 pack years, is diagnosed with a T2 N1 M0 lung cancer. EBUS (endoscopic
bronchial ultrasound) reveals small cell cytology. You order concomitant chemoradiation and start with chemotherapy
immediately. After 2 cycles, before starting radiotherapy, restaging shows stable disease (10% regression).
What is the appropriate next step?
A) Start chemoradiation

B) Continue chemotherapy for another 2 cycles, withhold radiation

C) Change chemotherapy regimen

D) Re-biopsy

E) Surgery

A45

A 62-year-old woman presents with 8kg weight loss over 1 year and a persistent cough over 3 months. She has a history of
type II diabetes and hypertension, both well controlled. A thoraco-abdominal CT reveals multiple pulmonary nodules, all
smaller than 1cm. In addition, there are enlarged retroperitoneal lymph nodes, some lytic vertebral bone lesions and a
cervical mass extending to the left pelvic wall. The biopsy of the cervical mass shows poorly differentiated squamous cell
cancer. Her performance status is 1 and she wishes the most active treatment.
What is the most adequate treatment?
A) Carboplatin, gemcitabine, bevacizumab

B) Cisplatin, paclitaxel, bevacizumab

C) Nivolumab

D) Trabectidine

E) Topotecan, paclitaxel, bevacizumab

A46

A 30-year-old non-smoking-man in good condition presents with lymph node, lung and liver metastases of TTF-1 and CK7+
adenocarcinoma. Staging procedures, including a PET scan, revealed no primary tumour.
Which is the most appropriate next step?
A) Order molecular pathological investigation of the tumour biopsy

B) Order serum levels of the tumour markers CEA, AFP, beta-HCG, Cyfra-21.1 and NSE

C) Start chemotherapy with cisplatin and etoposide

D) Start chemotherapy with cisplatin and pemetrexed

E) Start gefitinib
 A47

A 70-year-old woman, performance status 1, presents with severe vaginal bleeding because of a stage IVB clear cell
endometrial grade III carcinoma with multiple lymph node, peritoneal and lung metastases.
Which is the most appropriate treatment in this case?
A) Irradiation of the uterus followed by 6 courses carboplatin/paclitaxel

B) Megestrol acetate alternating with tamoxifen

C) Surgical cytoreduction followed by 6 courses carboplatin/paclitaxel

D) 6 courses carboplatin/paclitaxel/bevacizumab

E) 6 courses cisplatin, doxorubicin and cyclophosphamide

A48

Peptide receptor radionuclide therapy (PRRT) activity in neuroendocrine tumours is dependent on:
A) CD56 expression

B) Chromogranin A expression

C) Neuron specific enolase (NSE) expression

D) Somatostatin receptor expression

E) Synaptophysin expression

A49

A 86-year-old patient is admitted to the hospital because of an epileptic seizure. The MRI of the brain shows a round mass in
the right frontal lobe, with broad contact to the dura mater and some calcifications. There is a considerable perifocal oedema.
A CT scan of the chest and abdomen reveals no abnormalities. The patient has a history of prostate cancer 16 years
previously, cT1 cN0 M0 treated with radiotherapy with 74 Gy. His current PSA is 3.7 ng/ml. He was recently hospitalized for
hematuria: a stage T1a urothelial carcinoma was removed. He also experienced a non-ST elevation myocardial infarction
(NSTEMI) 2 months earlier. He takes low-dose aspirin and a beta-blocker.
What is the most likely diagnosis?
 A) Glioblastoma

B) Meningioma

C) Metastatic prostate cancer

D) Metastatic urothelial carcinoma

E) Neurocysticercosis (pork tapeworm infection of the CNS)

A50

A 70-year-old female patient is diagnosed with breast cancer (adenocarcinoma NST). The diagnostic workup reveals a cT3
(multicentric) cN1 M0 tumour with ER 15% positive, PR 2%, HER-2 negative, the Ki67 proliferation marker is 31%. The patient
has no concomitant diseases.
What is the correct management?
A) Breast conserving surgery (BCS) and lymphadenectomy, loco-regional radiotherapy and adjuvant endocrine
treatment

B) BCS and lymphadenectomy, adjuvant chemotherapy with 4 cycles of docetaxel and cyclophosphamide (TC), loco-
regional radiotherapy and endocrine treatment

C) Modified radical mastectomy (MRM), adjuvant chemotherapy with 4 cycles of docetaxel and cyclophosphamide (TC),
adjuvant endocrine treatment

D) MRM, adjuvant chemotherapy with 4 cycles of epirubicin and cyclophosphamide (EC) followed by 3 months of
weekly paclitaxel and radiotherapy to the regional lymph nodes

E) MRM, adjuvant chemotherapy with 4 cycles of epirubicin and cyclophosphamide (EC) followed by 3 months of
weekly paclitaxel, radiotherapy to the loco-regional lymph nodes and adjuvant endocrine treatment

A51

A 50-year-old woman is treated with nivolumab because of metastatic lung cancer. She presented with dyspneoea due to
pneumonitis grade II. No pathogen was cultured.
Which is the most appropriate approach after stopping nivolumab?
A) Restart nivolumab after 2 weeks if the patient has recovered

B) Start with corticosteroids and reintroduce nivolumab after the patient has recovered

C) Close observation, no further nivolumab treatment

D) Start with corticosteroids and infliximab, reintroduce nivolumab after the patient has recovered

E) Start with cyclophoshamide, no further nivolumab treatment

 A52

A 52-year-old patient with breast cancer receives the first cycle of an adjuvant (anthracyclin based) chemotherapy, and seven
days later experiences a fever of 38.7 °C. Laboratory tests are obtained, and her absolute neutrophil count is 0.3 x 10 9/L. She
has no focal symptoms. The MASCC (multidisciplinary association of supportive care in cancer) score shows high risk.
An appropriate strategy could consist of which of the following options?
A) Inpatient broad spectrum intravenous antibacterial therapy

B) Inpatient broad spectrum intravenous antibacterial therapy plus G-CSF

C) Inpatient oral antibacterial therapy

D) Outpatient management and oral antibacterial therapy

E) Outpatient management and oral antibacterial therapy plus G-CSF

A53

Which cytostatic drug has a severe interaction with aprepitant?

A) Cisplatin

B) Cyclophosphamide

C) Docetaxel

D) Doxorubicin

E) Irinotecan

A54

A 79-year-old frail man presented with a history of diarrhoea, acute diverticulitis and perforation. At laparotomy, an
unresectable tumour in the caecum and liver metastases in both lobes were detected. Histology showed a well differentiated
neuro-endocrine tumour (NET). The patient recovered from the complications of the diverticulitis. Which is the most
appropriate management of the patient with regard to the NET?
A) Cisplatin and etoposide

B) Everolimus

C) Interferon-alpha

D) Somatostatin analogue

E) Streptozotocin
 A55

A 45-year-old patient with a history of hypertension presented with a large (12cm) gastric mass. A thoraco-abdominal CT scan
reveals no other lesions. Biopsy shows a GIST with a high mitotic count. In the multidisciplinary tumour-board surgery is
considered feasible but would include removal of the spleen and pancreas in order to obtain an R0 resection.
What is the best way to proceed?
A) Active surveillance: repeat CT scan in 3-6 months

B) Neoadjuvant sunitinib for at least 6 months

C) Obtain a mutational analysis of the tumour

D) PET-CT scan to stage for metastatic disease

E) Primary resection followed by adjuvant imatinib for 3 years

A56

Which statement concerning high-grade osteosarcomas is correct?

A) Active chemotherapy agents include cisplatin, ifosfamide, doxorubicine, high dose methotrexate

B) Curative treatment includes neoadjuvant chemotherapy, surgery and adjuvant chemo- and radiotherapy

C) In case of a pathological fracture, the limb should be amputated

D) Multimodality treatment improves disease free survival by 20% compared to surgery alone

E) The peak incidence is between 25 and 29 years' age

A57

An 82-year-old patient has metastatic pancreatic cancer with severe abdominal pain, non-responsive to paracetamol. His liver
function is normal, the creatinine-clearance is 28ml/min.
What is the best pain management?
A) Ibuprofen

B) Morphine i.v.

C) Paracetamol/Codein

D) Tramadol

E) Transdermal Fentanyl
 A58

A patient with metastatic castration resistant prostate cancer and newly diagnosed bone metastasis starts treatment with
abiraterone acetate and denosumab. Eight weeks later he presents with dizziness and muscle cramps. The most likely
diagnosis is:
A) Hypokalemia due to abiraterone acetate

B) Hyperkalemia due to denosumab

C) Hypercalcemia due to abiraterone acetate

D) Hypocalcemia due to denosumab

E) Hypercalcemia due to paraneoplasia

A59

Which is the standard duration of adjuvant trastuzumab therapy in HER2- positive early breast cancer patients?
A) 3 months

B) 6 months

C) 9 months

D) 12 months

E) 24 months

A60

A 55-year-old woman in good clinical condition presents with two liver metastases of about 2cm in size. Further examination
does not reveal other lesions. She had a history of ER positive, PR positive and HER2 negative breast cancer and had been
treated with adjuvant chemotherapy (anthracycline, taxane), radiotherapy and adjuvant endocrine therapy with tamoxifen
until 2 years ago.
How would you proceed with this patient?
A) Biopsy of the liver metastasis with determination of ER-, PR- and HER2- status

B) Combination therapy with exemestane and the mTOR inhibitor everolimus

C) Endocrine therapy with anastrozole or letrozole

D) Locoregional treatment of the liver metastasis by radiofrequency ablation

E) Mono-chemotherapy with capecitabine

A61

Regarding metastatic breast cancer, for which of the following patients, current evidence supports the use of platinum-based
chemotherapy in second line?
A) BRCA-associated Triple Negative (TN) patients

B) BRCA-associated non-TN patients

C) ER+/HER2- patients

D) ER-/HER2+ patients

E) ER+/HER2+ patients
A62

A 60-year-old lady was started on bortezomib for multiple myeloma. One month after treatment start she presented with a
rash (see picture ).
What is the appropriate management?

A) Aciclovir

B) Flucloxaciline

C) Fluconazole

D) Steroids

E) Stop bortezomib

A63

A 37-year-old man underwent a palliative right-sided hemicolectomy because of a stenotic colon ascendens carcinoma with
extensive peritoneal metastases. Histology revealed adenocarcinoma of the colon G3, biomarker analysis showed KRAS and
NRAS wildtype and a BRAF V600E mutation. According to tumour board decision a palliative systemic treatment is
recommended for this patient without relevant comorbidities.
Which is the most effective first line protocol in terms of overall survival?
A) FOLFIRI + EGFR-antibody

B) FOLFIRI + bevacizumab

C) FOLFOXIRI + EGFR-antibody

D) FOLFOXIRI + bevacizumab

E) FOLFOXIRI + nivolumab
 A64

What is true of a traditional phase I trial?

A) The primary endpoint is response rate

B) The response rate in phase I is better than in a subsequent phase II trial

C) The dose where dose limiting toxicities occur is the maximum tolerated dose

D) Patients with all types of malignancies can be included

E) Usually 30-50 patients are required

A65

In a 65-year old male patient with a PS 1 a bronchial adenocarcinoma of the right upper lobe is found. The tumour measures
3.5 cm. PET-CT reveals metastases in the suprarenal glands, several vertebrae and 2 lesions in the liver. The patient is a heavy
smoker (60 pack years) and drinks 0.5 litre of red wine/day. He is known to have gout and mild cutaneous psoriasis. The PD-L1
expression in the tumour cells is 55%, no EGFR, ALK or ROS-1 mutations are found.
Which treatment will result in the best overall survival?
A) Pembrolizumab

B) Nivolumab

C) Cisplatin and Pemetrexed

D) Cisplatin, Gemcitabine and Bevacizumab

E) Carboplatin, Paclitaxel and Bevacizumab

A66

What is the standard first-line chemotherapy regimen for a patient with metastatic cholangiocarcinoma?
A) Oxaliplatin, 5-FU, leucovorin

B) Oxaliplatin, capecitabine

C) Oxaliplatin, gemcitabine

D) Cisplatin, gemcitabine

E) Irinotecan, 5-FU, leucovorin

A67

Which is the target of Ipilimumab?

A) PD-1

B) CD 30

C) PD-L1

D) CD 52

E) CTLA-4
 A68

A 45-year-old woman presented with retroperitoneal and mediastinal lymphadenopathy. Histologically squamous cell
carcinoma was diagnosed. No primary tumour was found by CT and MR scanning, endoscopy, bronchoscopy, ENT-endoscopy
and gynaecologic examination. Further tissue examination revealed positivity for human papilloma virus.
Which is the most probable diagnosis?
A) Bladder cancer

B) Cervical cancer

C) Oesophageal cancer

D) Head and neck cancer

E) Lung cancer

A69

A 64-year-old man in good performance status and otherwise healthy state presents with macrohematuria. An abdominal
ultrasound reveals a 10cm mass in the right kidney. Additional CT staging shows multiple 1cm lung metastases.
The next step should be:
A) Biopsy of lung nodules

B) Biopsy of the tumour

C) Immediate systemic treatment with anti VEGFR targeted therapy

D) PET scan staging

E) Surgery of the primary tumour

A70

Which of the following statements with regard to primary brain tumours is appropriate?
A) LOH 1p/19q is predictive of responsiveness to chemotherapy

B) PET-CT evaluation should be performed for response evaluation

C) Systemic staging should be performed prior to start of treatment

D) Temozolomide mono chemotherapy is the treatment of choice in grade IV malignant glioma

E) With an incidence of 50/100 000, malignant glioma is the most frequently diagnosed brain tumour
 A71

Which is the most common epithelial ovarian cancer subtype?

A) Clear cell carcinoma

B) Endometrioid carcinoma

C) High-grade serous carcinoma

D) Low-grade serous carcinoma

E) Mucinous carcinoma

A72

A patient with adenocarcinoma of the lung with a known EGFR exon 19 mutation has been treated with an EGFR TKI for 12
months. Staging CT shows progression of the primary and new liver metastases.
Which is the most likely cause of progression in this patient?
A) c-MET amplification

B) HER2 amplification

C) KRAS mutation

D) Point mutation in c-MET

E) T790M mutation

A73

A 75-year-old man presents with splenomegaly, enlarged lymph nodes in axillae, and the para-aortic region. Blood counts: Hb
6 mmol/l (10 g/l), platelets 95 x 109/l, leucocytes 24 x 109/l with 69% monoclonal lymphocytes, CD20+, CD5+, CD23-, Ig-M+,
Ig-D+. Lymph node biopsy: monoclonal lymphocytes, Cyclin D1+.
What is the most likely diagnosis?
A) Chronic lymphatic leukaemia/small lymphocytic lymphoma

B) Diffuse large B-cell lymphoma

C) Follicular lymphoma

D) Mantle cell lymphoma

E) Marginal zone lymphoma

 A74

A fit 20-year-old man has a primitive neuro-ectodermal tumour (PNET, Ewing tumour group) of the chest wall without
metastases.
Which treatment should the patient receive?
A) Chemotherapy consisting of ifosfamide, etoposide, doxorubicin, vincristine, dactinomycin, cyclophosphamide,
surgery, radiotherapy

B) Radical surgery

C) Radical surgery followed by radiotherapy

D) Radiotherapy

E) Six cycles with high dose doxorubicin and ifosfamide, followed by surgery and radiotherapy

A75

Which cancer's incidence is NOT elevated in BRCA-1/2 mutation carriers?

A) Gastric cancer

B) Breast cancer

C) Ovarian cancer

D) Testicular cancer

E) Prostate cancer

A76

Metastatic melanoma harbouring a BRAFV600-mutation can be treated with a combination of BRAF- and MEK- inhibitors.
Which statement concerning this combination therapy in comparison to BRAF-inhibitors monotherapy is NOT true?
A) Improvement of tumour pain

B) Increase of skin side effects

C) Increase of response rate

D) Prolongation of overall survival

E) Prolongation of progression free survival

 A77

The international workshop on chronic lymphocytic leukaemia defined criteria for 'active disease', identifying patients for
whom therapy is indicated.
Which parameter is NOT an indication for treatment?
A) Abdominal pain due to splenomegaly

B) Autoimmune anaemia poorly responsive to treatment with corticosteroids

C) Blood lymphocyte count of >100 x 109/I

D) Bone marrow infiltration, manifested by Hb ≤ 6 mmol/I (≤ 10g/dl) and/or thrombocytes < 100 x 10 9/I

E) Presence of B-symptoms

A78

Which statement about peripheral neuropathy (PN) secondary to chemotherapy is NOT true?
A) Newer vinca alkaloids (vinorelbine, vinflunine) induce milder sensory neuropathy

B) PN is commonly associated to microtubule-targeting agents

C) PN occurs less frequently with NabPaclitaxel compared to standard (polyoxyethylated castor oil-based) paclitaxel

D) Severity of PN is drug, dose and schedule dependent

E) The first-generation vinca alkaloids (vincristine) are associated with severe mixed sensory and motor neuropathy

A79

A 58-year-old man was diagnosed with a metastatic gastro-oesophageal junction cancer (adenocarcinoma G3, HER2
negative). He received a platinum - fluoropyrimidine doublet chemotherapy as first-line treatment. Tumour progression was
observed after 4 cycles.
Which one is NOT an appropriate monotherapy option?
A) Docetaxel

B) Irinotecan

C) Placlitaxel

D) Capecitabine

E) Ramucirumab

A80

Which of the following skin toxicities is NOT typically observed during single-agent treatment with an anti-EGFR monoclonal
antibody?
A) Hand-foot syndrome

B) Paronychia

C) Photosensitivity

D) Pruritus

E) Xerosis
Type K – Quadruple
Correct (T)
Incorrect (F)
The correct answers are marked in bold

K1
A 51-year-old perimenopausal woman was diagnosed with breast cancer (invasive ductal adenocarcinoma G2, ER/PR positive,
HER2 negative) in a core biopsy triggered by a finding on screening mammography. She is asymptomatic and otherwise
healthy.
Which assessment(s) is/are indicated as next step(s) for further treatment decisions?
A) PET/CT scan

B) Serum oestradiol/FSH

C) Serum CA 15-3

D) Ultrasound of axilla ultrasound of axilla

K2
According to the ESMO Guidelines which of the following statements concerning gastrointestinal (GI) toxicity of immune
checkpoint inhibitors is/are correct?
A) Calcium/vitamin D supplementation and pneumocystis prophylaxis is recommended for systemic steroid use > 4
weeks

B) Intense immunosuppression with infliximab for severe GI toxicity is associated with decreased treatment efficacy

C) Median time to onset of severe GI toxicity with PD1- or PD-L1-inhibitor monotherapy is 12 weeks

D) Tapering of corticosteroids after response to initial 4-day intravenous treatment with 1-2 mg/kg methylprednisolone
for grade 3 diarrhoea is recommended over 6-8 weeks

K3
Which statement(s) is/are correct?
Microsatellite instability (MSI)
A) is associated with good prognosis in early stage colorectal cancer.

B) is found in 20 % of patients with stage IV colon cancer.

C) is a condition of genetic hypomutability.

D) results from defects of the mismatch repair system.

K4
A 73-year-old female never smoker is diagnosed with metastatic adenocarcinoma of the left upper lobe of the lung.
Performance status is ECOG 0. PD-L1 expression is 70 %. Molecular analyses reveal a translocation in the ALK gene.
Which is/are the appropriate treatment(s)?
A) Alectinib

B) Crizotinib

C) Nivolumab

D) Pemetrexed-containing chemotherapy
K5
Patients with asymptomatic, stable advanced follicular lymphoma (FL) do not require immediate treatment but should be
followed closely.
Which of the following is/are clear indication(s) to start therapy?
A) Age ≤ 60 years

B) Elevated LDH and beta-2 microglobulin

C) Night sweats

D) Symptomatic extranodal disease

K6
Concerning human papilloma virus (HPV) positive oropharyngeal cancer (OPC), which of the following statements is/are
correct?
A) HPV-positive OPCs have a favourable prognosis

B) HPV positivity is sufficiently defined by immunohistochemistry of P16

C) HPV status is part of the current AJCC classification system

D) Radiotherapy in combination with cetuximab is a validated de-escalation strategy in locally-advanced disease

K7
In a phase III trial, patients with metastatic cancer are randomized between standard treatment and the new drug Esmolalib.
Median survival (primary endpoint) with 800 included patients is 7.5 months for Esmolalib and 7 months for the standard
treatment; HR = 0.88 (95% CI 0.79 – 0.97); p-value 0.04.
Which of statement(s) is/are correct?
A) 200 patients on standard treatment have died within 7 months of randomization

B) Based on this trial, Esmolalib is the new standard of care

C) The standard treatment and Esmolalib are equally effective

D) There is a 4% chance that the results are random

K8
A 33-year-old male patient is diagnosed with a melanoma on his back (Breslow 2.3 mm with ulceration, BRAF wildtype) and a
positive sentinel node biopsy (> 1 mm).
Which of the following statements is/are correct for this patient?
A) A complete lymph node dissection improves overall survival

B) Adjuvant local radiotherapy is indicated

C) Adjuvant immunotherapy with nivolumab improves recurrence-free survival

D) Adjuvant treatment with dabrafenib and trametinib improves overall survival

K9
What is correct for radiotherapy in non-metastatic soft tissue sarcomas (STS)?
A) It is of benefit after a full compartmental resection

B) It is indicated for STS after a R1 resection, if further resection is not feasible

C) It should be offered, in addition to surgery, for cases with a deep low-grade STS

D) Preoperative vs. postoperative radiotherapy results in similar local control

K10
Typical side effect(s) of 2nd and 3rd generation Tyrosine Kinase Inhibitors (dasatinib, nilotinib, bosutinib, ponatinib) in Chronic
Myeloid Leukaemia (CML) is/are:
A) Cardiovascular complications

B) Diarrhoea

C) Mucositis

D) Pleural effusion

K11
What is true concerning systemic therapy for recurrent or metastatic squamous cell cancer of the head and neck?
A) Cisplatin/5-FU significantly improves overall survival compared to weekly methotrexate as first-line treatment

B) Docetaxel significantly improves overall survival compared to methotrexate in first-line treatment

C) The addition of cetuximab to cisplatin/5-FU significantly improves overall survival compared cisplatin/5-FU alone as
first-line treatment

D) Nivolumab significantly improves overall survival compared to methotrexate or docetaxel as second-line treatment
after cisplatin/5-FU

K12

Febrile neutropenia (FN) is one of the most frequent and serious complications of cancer chemotherapy.
Which are risk factors for FN - additional to the intensity of the chemotherapeutical regimen?
A) Age < 60 years

B) Cardiovascular disease

C) History of prior FN

D) Mucositis

K13

Which of the following drugs should NOT be given to a patient with a creatinine clearance of 25 ml/min?
A) Capecitabine

B) Carboplatin

C) Methotrexate

D) Paclitaxel
 K14

In case of liver function impairment (bilirubin elevation >2x ULN), which of the following drugs should be dose reduced or
omitted?
A) Capecitabine

B) Carboplatin

C) Docetaxel

D) Irinotecan

K15

Which of the following drugs can be combined safely with concomitant radiotherapy (without dose reduction)?
A) Doxorubicin

B) Cisplatin

C) Gemcitabine

D) Vemurafenib

K16

Thyroid cancer incidence is increasing.

Which of the following statements is/are correct?
A) Papillary thyroid cancer is the predominant pathological type

B) Sorafenib is recommended in radio-iodine refractory differentiated thyroid cancer

C) Age is a component of the current AJCC staging system

D) BRAF mutations are common in medullary thyroid cancer

K17

In pregnant women with malignant diseases:

A) Bevacizumab can be given in the 2nd and 3rd trimester

B) CHOP chemotherapy can be given during 2nd and 3rd trimester

C) Hormonal treatment for breast cancer should be avoided

D) Trastuzumab can be administered in the 2nd and 3rd trimester

 K18

Which of the following statements concerning BRAF is correct?

A) BRAF (V600E) mutations are present in about 80% of metastatic melanomas

B) BRAF mutations are frequently present in mucinous ovarian cancer

C) BRAF mutations can be found in 80% of hairy cell leukaemia

D) In metastatic colorectal cancer BRAF mutations are considered to be a negative prognostic factor

K19

A 67-year-old woman presents in the emergency room with her sister who complains the patient has behavioural problems,
namely an altered personality, she has become conflicting. A brain MRI shows a solitary frontal lobe lesion of 3cm. Thoraco-
abdominal CT scan was normal. Her past medical history is relevant for the excision of a pigmented right scapula skin lesion 6
years before.
At this point, which measures of diagnostic work-up are most useful?
A) Biopsy of brain lesion

B) Obtain the histological diagnosis of the excised skin lesion

C) Perform PET-CT

D) Perform gastro- and colonoscopy

K20

A patient with metastatic castration resistant prostate cancer who has not received prior chemotherapy is progressing with
mildly symptomatic new bone metastasis and lymph nodes of 5cm diameter in his pelvis. Possible next treatment options are:
A) Abiraterone acetate plus steroids

B) Cabazitaxel plus steroids

C) Docetaxel plus steroids

D) RAD-223

K21

Abiraterone is a treatment for patients with castration resistant advanced prostate cancer.
Which of the following statements is true?
A) Is not indicated in patients with very high PSA level

B) Is used with steroids

C) The key mechanism of action is inhibition of CYP17 enzyme

D) Typical toxicity is fluid retention and hypertension

 K22

Regarding pancreatic adenocarcinoma:

A) Adjuvant radiotherapy is ineffective according to randomized data

B) The most prevalent familial syndrome is a BRCA2 germline mutation

C) The most prevalent risk factors are alcohol consumption and obesity

D) The standard lymphadenectomy in Whipple procedure includes a minimum of 10 resected nodes