Question 1
A 58-year-old male patient with a history of metastatic non-small cell lung cancer (NSCLC) is being considered for a new line of therapy after progression on first-line treatment. The patient’s tumor is positive for an EGFR exon 19 deletion. Which of the following medications is most appropriate to initiate as second-line therapy?
A) Pembrolizumab
B) Afatinib
C) Cisplatin
D) Carboplatin
E) Docetaxel
Rationale: This drug is a tyrosine kinase inhibitor (TKI) that targets the epidermal growth factor receptor (EGFR), which is effective in NSCLC patients with EGFR mutations, including exon 19 deletions. Pembrolizumab, a PD-1 inhibitor, is commonly used in NSCLC but is more appropriate for patients with high PD-L1 expression without EGFR mutations. Cisplatin and Carboplatin are platinum-based chemotherapies that serve as first-line treatments rather than specific targeted therapies for patients with EGFR mutations. Docetaxel is a chemotherapy agent used in second-line treatment but is not as specific or effective as afatinib in patients with EGFR exon 19 deletions.
Question 2
A 45-year-old female with HER2-positive metastatic breast cancer is experiencing progression of disease despite treatment with trastuzumab and pertuzumab. Which of the following agents represents the best option for further treatment?
A) Lapatinib
B) Tamoxifen
C) Anastrozole
D) T-DM1 (Trastuzumab emtansine)
E) Paclitaxel
Rationale: This drug is an antibody-drug conjugate combining trastuzumab with a cytotoxic agent, specifically indicated for HER2-positive metastatic breast cancer patients who have previously received trastuzumab and taxanes. It is effective in this setting due to its targeted delivery of chemotherapy to HER2-expressing cells. Lapatinib is another HER2-targeted therapy but would be less preferable compared to T-DM1 after progression on trastuzumab and pertuzumab. Tamoxifen and anastrozole are hormone therapies used primarily in hormone receptor-positive breast cancer, not based on HER2 status. Paclitaxel is a chemotherapeutic agent that may be used in breast cancer but does not provide the targeted approach required for HER2-positive disease after trastuzumab and pertuzumab failure.
Question 3
A patient with chronic myeloid leukemia (CML) presents with fatigue, weight loss, and night sweats. A bone marrow biopsy confirms the diagnosis. Which of the following medications is the first-line treatment for this condition?
A) Imatinib
B) Cyclophosphamide
C) Vincristine
D) Rituximab
E) Hydroxyurea
Rationale: This drug is a tyrosine kinase inhibitor that targets the BCR-ABL fusion protein characteristic of CML, making it the first-line treatment for patients with this diagnosis. Cyclophosphamide and Vincristine are chemotherapeutic agents not primarily used in the first-line treatment of CML. Rituximab is a monoclonal antibody against CD20, used in certain types of non-Hodgkin lymphoma and chronic lymphocytic leukemia, not CML. Hydroxyurea may be used in the management of CML but primarily in cases where TKIs like imatinib are not tolerated or in specific patient populations.
Question 4
A 67-year-old male with advanced prostate cancer is being considered for new medication after showing progression on standard androgen deprivation therapy. Which of the following drugs is most appropriate to add to his treatment regimen?
A) Enzalutamide
B) Fluorouracil
C) Methotrexate
D) Doxorubicin
E) Cetuximab
Rationale: This drug is an androgen receptor inhibitor that provides clinical benefit in patients with prostate cancer who have progressed on androgen deprivation therapy. It works by further inhibiting the action of androgens on the prostate cancer cells. Fluorouracil, Methotrexate, and Doxorubicin are chemotherapeutic agents with broad applications in cancer treatment but are not the most appropriate options for prostate cancer patients specifically progressing after androgen deprivation therapy. Cetuximab, an EGFR inhibitor, is not used in the treatment of prostate cancer, as prostate cancer does not typically express EGFR in a way that makes it a viable target for this therapy.
Question 5
A 55-year-old woman with metastatic colorectal cancer is scheduled to start chemotherapy. She is found to have a KRAS wild-type tumor. Which of the following medications can be added to her chemotherapy regimen to improve outcomes?
A) Cetuximab
B) Sunitinib
C) Sorafenib
D) Bevacizumab
E) Axitinib
Rationale: This drug is a monoclonal antibody against the epidermal growth factor receptor (EGFR) and is indicated for use in metastatic colorectal cancer with KRAS wild-type tumors, as it has been shown to improve outcomes when added to standard chemotherapy in this patient population. Sunitinib, Sorafenib, and Axitinib are tyrosine kinase inhibitors with different targets and are not used in the treatment of KRAS wild-type metastatic colorectal cancer. Bevacizumab is an anti-VEGF antibody that could also be used in metastatic colorectal cancer, but cetuximab is specifically chosen here due to the patient’s KRAS wild-type status, indicating a potential better response to EGFR inhibition.
Question 6
A patient with acute lymphoblastic leukemia (ALL) is undergoing induction chemotherapy. Which of the following medications is most commonly used in the induction phase for this condition?
A) Vincristine
B) Tamoxifen
C) Gefitinib
D) Allopurinol
E) Dabrafenib
Rationale: This drug is a part of the standard chemotherapy regimen for induction therapy in acute lymphoblastic leukemia (ALL), usually in combination with other drugs such as steroids, anthracyclines, and asparaginase. This combination is effective in achieving remission in a high percentage of patients. Tamoxifen is used in hormone receptor-positive breast cancer, not leukemia. Gefitinib is a tyrosine kinase inhibitor used in non-small cell lung cancer. Allopurinol is used to prevent hyperuricemia during chemotherapy but is not a treatment for ALL itself. Dabrafenib is a BRAF inhibitor used in melanoma and other cancers harboring BRAF mutations, not typically in ALL.
Question 7
A 63-year-old male with advanced renal cell carcinoma (RCC) has progressed on first-line sunitinib therapy. Which of the following agents is the most appropriate next step in treatment?
A) Cabozantinib
B) 5-Fluorouracil
C) Cisplatin
D) Trastuzumab
E) Rituximab
Rationale: This drug is a tyrosine kinase inhibitor with demonstrated efficacy in renal cell carcinoma, especially in patients who have progressed on prior VEGF-targeted therapy such as sunitinib. It targets multiple pathways involved in tumoral angiogenesis, growth, and metastasis. 5-Fluorouracil, Cisplatin, and Rituximab are not typically used in the treatment of RCC. Trastuzumab is used in HER2-positive breast cancer and certain gastric cancers, not in renal cell carcinoma, where such targets are not commonly expressed.
Question 8
A patient with Hodgkin lymphoma is in remission but requires consolidation therapy. Which of the following is the most appropriate option for consolidation therapy in this setting?
A) Imatinib
B) Brentuximab vedotin
C) Bortezomib
D) Osimertinib
E) Pembrolizumab
Rationale: This drug is an antibody-drug conjugate that targets CD30, which is expressed on the surface of Hodgkin lymphoma cells. It is used as consolidation therapy in patients at high risk of relapse or who have relapsed, to improve survival outcomes. Imatinib, a BCR-ABL tyrosine kinase inhibitor, is used in chronic myeloid leukemia and some gastrointestinal stromal tumors, not Hodgkin lymphoma. Bortezomib is a proteasome inhibitor used in multiple myeloma. Osimertinib is an EGFR tyrosine kinase inhibitor used in non-small cell lung cancer. Pembrolizumab, a PD-1 inhibitor, may have a role in relapsed or refractory Hodgkin lymphoma but is not typically used as consolidation therapy in the remission setting.
Question 9
A 50-year-old woman with BRAF V600E mutant metastatic melanoma is being evaluated for targeted therapy. Which of the following medications is the most appropriate choice for her treatment?
A) Trastuzumab
B) Cetuximab
C) Vemurafenib
D) Sunitinib
E) Nivolumab
Rationale: This drug is a BRAF inhibitor specifically indicated for the treatment of BRAF V600E mutation-positive metastatic melanoma. This medication directly targets the mutated BRAF protein, inhibiting the aberrant signaling pathway that promotes tumor cell growth and survival in patients with this mutation. Cetuximab is an EGFR inhibitor used primarily in colorectal and head and neck cancers. Trastuzumab is a HER2/neu receptor antagonist used in HER2-positive breast and gastric cancers. Sunitinib is a multi-targeted receptor tyrosine kinase inhibitor used in renal cell carcinoma and gastrointestinal stromal tumors, not in melanoma. Nivolumab, a PD-1 inhibitor, is an immunotherapy option for melanoma but not specifically targeted therapy for BRAF mutations.
Question 10
A 68-year-old man with chronic lymphocytic leukemia (CLL) who has relapsed after initial chemotherapy is being considered for a new treatment regimen. Which of the following agents is specifically indicated for the treatment of relapsed CLL?
A) Gemcitabine
B) Paclitaxel
C) Doxorubicin
D) Carboplatin
E) Ibrutinib
Rationale:This drug is a Bruton’s tyrosine kinase (BTK) inhibitor used in the treatment of several B-cell malignancies, including chronic lymphocytic leukemia (CLL), particularly in patients who have relapsed or are refractory to initial therapies. It works by inhibiting the signaling pathways that promote the survival and proliferation of malignant B cells. Paclitaxel, Doxorubicin, Carboplatin, and Gemcitabine are chemotherapeutic agents used in a variety of cancers, but they are not as targeted or as effective as ibrutinib in the context of relapsed CLL, where targeted inhibition of B-cell receptor signaling has proven to be a highly effective treatment strategy.
