Assessment Review Flashcards
True or False; in metastatic lung cancer, the presence of an oncogenic driver mutation and use of targeted therapy increases survival compared with not having a driver mutation and/or being treated with standard of care
True
True or False; the FDA and NIH define a biomarker as an indicator of advanced/metastatic cancer
False
Which of the following biomarkers would answer the question: “What is the likelihood of response to a treatment?”
Diagnostic
Monitoring
Predictive
Prognostic
Predictive
The statement “Lung cancer is a heterogeneous disease” indicates that there are:
Multiple testing modalities to assess for biomarkers
Many disease drivers
A variety of ways to obtain tissue or liquid biopsies
Many disease drivers
Which statement is FALSE? The NCCN NSCLC guidelines recommend the use of liquid biopsy when:
The patient is not medically fit for invasive tissue sampling
There is insufficient tissue for molecular analysis and follow-up tissue-based analysis will be done if a genetic abnormality is not identified by liquid biopsy
The pathologist orders liquid biopsy to decrease turnaround
A tumor doesn’t shed sufficient DNA for detection
A tumor doesn’t shed sufficient DNA for detection
True or False; all actionable and emerging biomarkers, except PD-L1, can be tested with both tissue and liquid biopsy
True
All of the following testing modalities may be used to test for KRAS mutations EXCEPT:
FISH
PCR
Sanger Sequencing
NGS
FISH
True or False; an LDT is a type of in vitro diagnostic test that is designed, manufactured and used within a single laboratory and has been approved for use by the FDA
False
True or False; a CDx is a test for a specific biomarker that was used in the pivotal clinical trial of a corresponding FDA-approved drug
True
True or False; the turnaround time for PCR is typically longer than NGS
False
True or False; PD-L1 testing can be performed by NGS
False
An actionable biomarker:
Identifies a population eligible for an FDA-approved targeted therapy
Is under investigation with the goal of identifying appropriate therapies for benefits
Should be tested only after the patient progresses on first-line therapy to guide the physician’s “action” of deciding upon subsequent therapy
Identifies a population eligible for an FDA-approved targeted therapy
Which of the following an “emerging” biomarker?
EGFR
ALK
BRAF V600E
KRAS G12C
KRAS G12C
Cell-free DNA (cfDNA) are DNA fragments released from normal and cancer cells following necrosis or apoptosis that circulate in bloodstream
True
Which of the following test methodologies allows for the simultaneous sequencing of millions of DNA fragments?
IHC
dPCR
NGS
IHC and NGS
NGS
KRAS G12C is often already included in many NGS testing panels. What might be an obstacle for the physicians when looking back to find the results of KRAS testing?
Interpreting the test results
Finding the results of specific KRAS G12C test results within the report or within the HER
Both
Both
Activating RAS mutations results in general metabolic reprogramming, causing KRAS to remain in the active state longer than is needed by the cell, resulting in:
Uncontrolled cell growth
Acquired drug resistance to TKIs
Prolonged cell survival
Increased apoptosis
Uncontrolled cell growth
Prolonged cell survival
KRAS G12C accounts for nearly ___ of all KRAS mutations
1/4
1/3
1/2
2/3
1/2
KRAS mutation are frequently seen in:
Codon 12
Chromosome 12
Exon 12
Codon 12
In normal physiology, KRAS activation results in cell:
Proliferation
Maturation
Differentiation
Metastasis
Proliferation
Maturation
Differentiation
True or False; in NSCLC, KRAS mutations are usually considered to be truncal mutations, meaning that they occur early and are likely to remain unchanged throughout the evolution of tumor cells
True
True or False; KRAS G12C and other actionable mutations are mutually exclusive. Clinically, this means that KRAS G12C-mutated NSCLC is unlikely to benefit from existing targeted therapies
True
True or False; the mutation designation KRAS G12C indicates that the normal GLYCINE at position 12 of KRAS has been replaced by a CYSTEINE
True
KRAS proteins are ___ switches, cycling between “on” and “off” states during signal transduction
Transcription
Concordance
Binary
Transmembrane
Binary
To transmit signals, KRAS must be turned on by exchanging ___ for ___.
GAP, GEF
GEF, GAP
GDP, GTP
GTP, GDP
GDP, GTP
True or False; according to CAP/IASLC/AMP molecular testing guidelines, KRAS molecular testing is indicated as a routine stand-alone assay as a sole determinant of targeted therapy
False
In recent years, the appreciation for the heterogeneity of lung cancer biology has prompted the use of testing to assess the presence of oncogenic driver mutations, which can be defined as:
Genomic changes critical to cancer development and maintenance
Extracellular ligands that fail to connect with their receptors
Proteins that block the blinding of PD-L1 to PD-1 to allow T-cells to kill tumor cells
Genomic changes critical to cancer development and maintenance
What is “precision medicine”?
Using personal information, such as smoking history, age, and family history to ascertain one’s risk for developing a disease, such as cancer.
Also known as personalized medicine, using information about a person’s genes or proteins to help prevent, diagnose, or treat disease
Also known as personalized medicine, in which the patient determines how they wish their cancer to be treated
Also known as personalized medicine, using information about a person’s genes or proteins to help prevent, diagnose, or treat disease
What is the goal of biomarker testing in NSCLC?
To determine whether a patient should receive surgery or immunotherapy
To undercover the reason why a non-smoker developed cancer, because lung cancer is always due to smoking
To determine the optimal treatment of patients newly diagnosed with NSCLC
To determine the optimal treatment of patients newly diagnosed with NSCLC
KRAS has the highest prevalence amongst actionable and emerging biomarkers. What is the prevalence of KRAS G12C amongst patients with NSCLC in the US?
8%
13%
44%
56%
13%
