Oncology Self-Study: Lung and Genitourinary Cancers

Nov 08, 2018

Test your knowledge of lung and genitourinary cancers with questions from self-evaluation activities on ASCO University.

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Correct answers are listed at the bottom of the page. Find complete answer rationales and suggested reading below.

  1. A 30-year-old woman was incidentally found to have an anterior mediastinal mass in her late 20s. A biopsy revealed a possible thymoma, and the patient was taken for a resection of her tumor. As per an outside report, pathologic examination revealed a thymic carcinoma and showed that the tumor was completely encapsulated. It was unclear if an assessment of mediastinal lymph nodes or distant disease was performed at that time. She now presents with left-sided chest wall pain. CT imaging reveals a large recurrent anterior mediastinal mass, mediastinal adenopathy, three distinct pleural lesions on the left, and a small pericardial effusion. A biopsy of the anterior mediastinal mass shows a squamous cell carcinoma, p63 positive, CD5 positive, and CD117 (KIT) positive on immunohistochemistry, consistent with recurrent thymic carcinoma.

Which of the following is associated with the highest response rate for this disease?

  1. Carboplatin and paclitaxel
  2. Sunitinib
  3. Carboplatin and vincristine with prednisone
  4. Everolimus
  5. Nivolumab
  1. A 68-year-old man with an episode of hematospermia has a prostate-specific antigen (PSA) evaluation which returns at 10.4 ng/dL. A subsequent prostate biopsy reveals cancer in 6 of 12 cores located bilaterally with a Gleason score of 4 + 5 = 9 and a prostate volume of 36 cc. A technetium whole body bone scan and CT of the abdomen and pelvis do not identify any lymphadenopathy or distant metastases. He discusses options of definitive therapy with his multidisciplinary team.

Which of the following is the most appropriate treatment plan?

  1. External Beam radiation therapy with 28 months of androgen deprivation therapy
  2. He is not a candidate for external beam radiation therapy
  3. External beam radiation therapy with 6 months of androgen deprivation therapy      
  4. External beam radiation therapy without androgen deprivation therapy
  5. Active surveillance with yearly prostate biopsy and PSA evaluation

Rationale

1:A

For the first-line treatment of metastatic thymic carcinoma, carboplatin and paclitaxel is recommended. This combination has the highest response rate in clinical trials in this disease. Sunitinib and everolimus are second-line treatment options for thymic carcinoma with lower response rates. Nivolumab has not been tested in patients with thymic carcinomas. Carboplatin and vincristine is not an appropriate standard treatment regimen for this disease.

Suggested Readings

Lemma GL, Lee JW, Aisner SC, et al. J Clin Oncol. 2011;29;2060-2065.                        

NCCN Guidelines, Thymomas and Thymic Carcinomas, Version 2.2018.    

2:A

This patient has a high-grade, high-risk prostate cancer without metastatic disease. He is a candidate for definitive therapy through a radiation or surgical approach. This patient has no noted contraindications to radiation therapy and thus should be considered for this approach. There are multiple studies identifying the benefits of androgen deprivation therapy in conjunction with radiation therapy. While the duration of therapy may be different in many of those studies, there have been direct comparisons in which 4 months of therapy is likely too little and patients should receive at least 18 months of therapy. The EORTC 22961 trial compared 6 months to 36 months of androgen deprivation therapy (ADT) with an improved progression free survival in the group receiving 36 months. The DART01/05 GICOR Trial compared 4 months with 28 months of therapy with a benefit seen in overall survival in the group receiving 36 months of therapy. This patient is not a good candidate for active surveillance given his elevated Gleason score and large volume of disease.

Suggested Readings

Bolla M, Reijke TM, Tienhoven GV, et al. N. Engl. J. Med. 2009;360.24;2516-2527.

Zapatero A, Guerrero A, Maldonado X, et al. Lancet Oncol. 2015; 16.3;320-327.    

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