10/2/2014

CME/CE Test Questions and Answers

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ProgressiveHR+/HER2BreastCancer:ACMEVirtualPatient Simulation
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Belowareallthetestquestionswithanexplanationofthecorrectanswer. 1. Whyisendocrinetherapypreferredoverchemotherapyinpatientswithadvancedbreastcancer? Answer:Ithaslowertoxicityandiseasiertoadminister Inpatientswithadvanceddisease,endocrinetherapyisoftenadministeredasinitialtherapyandis favoredoverchemotherapybecauseofitsclinicalactivity,lowtoxicity,andeaseoftreatment.Surgery isalsoanoptionincasesofadvanceddiseasewhenmetastasisislimitedandwelldefined,andthusit maybecoupledwithadjuvantendocrinetherapy.Inendocrinetherapy,treatmentinvolvessequencing agentsuntiltheonsetofintolerance,resistance,ordiseaseprogressionthatnecessitatestheswitchto chemotherapy. 2. WhichtherapyisbestforapremenopausalpatientwithHR+,stageIVbreastcancer? Answer:Endocrinetherapyandovarianablationorsuppression TheNationalComprehensiveCancerNetwork(NCCN)ClinicalPracticeGuidelinesinOncology,Breast Cancer,Version3.2013recommendthatendocrinetherapybegiventopatientswithHR+,recurrentor stageIVbreastcancer.Inpostmenopausalwomen,thepossibleagentsincludeselectiveestrogen receptormodulators(SERMs),AIs,andselectiveestrogendownregulators(SERDs).AIsstopestrogen productionandareusedonlyinpostmenopausalwomen.Forpremenopausalwomen,endocrinetherapy isusedinconjunctionwithovarianablation(bysurgicaloophorectomyorirradiation)orsuppression (usingluteinizinghormonereleasinghormoneagonists). 3. Whatis1waytoovercomeresistancetoendocrinetherapy? Answer:UseanmTORinhibitorinconjunctionwithendocrinetherapy OnemechanismofresistancetoendocrinetherapyisactivationofthemTOR(mammaliantargetof rapamycin)signalingpathway.ThishasraisedtheprospectofusingmTORinhibitorsinconjunctionwith endocrinetherapytomodulateresistance. 4. EuropeanSocietyforMedicalOncology(ESMO)guidelinesrecommendwhichdrug(s)asfirstlinetreatment forpostmenopausalwomenwithHR+metastaticbreastcancer(MBC)whohavealreadybeentreatedwith anastrozole? Answer:Tamoxifen RecentguidelinesfromtheESMOforwomenwithHR+,locallyrecurrentormetastaticdiseasestatethat theSERMtamoxifenplusovarianablationisthepreferredoptionforpremenopausalwomen.For postmenopausalwomen,ESMOguidelinesrecommendasfirstlinetreatmentthethirdgenerationAIs (anastrozole,letrozole,orexemestane)iftheyhavenotbeenadministeredpreviouslyotherwise, tamoxifenisanacceptablefirstlineoption.Secondlinehormonetherapyforpostmenopausalpatients mayincludetamoxifen,anastrozole,letrozole,exemestane,fulvestrant,theprogestinmegestrolacetate, andandrogens. 5. ApatientpresentswithsuspectedMBCand,uponexamination,asupraclavicularnodeisfound.Which test(s)shouldbeorderedfirst? Answer:Fineneedleaspiration(FNA) FNAofthenodeshouldbeamongthefirsttestsordered,especiallyifthenodecanbeeasilyaspirated. OftenanFNAwillprovideadequatematerialforacellblockallowingfurtherevaluationofthetumor, includingassessmentofmarkers. 6. InapatientwithsuspectedMBCandapossiblefracture,whichtest(s)shouldyouorder? Answer:Positronemissiontomography(PET)/contrasttomography(CT) AdiagnosiscouldbemadewitheitheraCTandabonescanoraPET/CT.Thechoicewillbedrivenby localavailabilityandcost.

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