GI

Question 1

What is the relationship of BRAF to Lynch syndrome

Answer 1

They are mutually exclusive

Question 2

What is the relationship of MSI to BRAF in CRC

Answer 2

They are mutually exclusive

Question 3

Molecular testing needed for m1 colon adenocarcinoma

Answer 3

• PDL1
• BRAF / MSI /
• HER2
• TMV
• KRAS / NRAS

Question 4

Sidedness
-RAS/RAF
-bev responsiveness
- EGFR responsiveness

Answer 4

R>L RAS/RAF
R>L. bev responsiveness
L>R. EGFR responsiveness***

*** response seen when RAS/RAF wt

Question 5

First line m1 colon adenocarcinoma

Answer 5

1 - FOLFOX / FOLFIRI
+/- Bev

3 - FOLFOXIRI - convert to respectability

Question 6

Second line M1 colon adenocarcinoma

Answer 6

PDL1 / TMB high - pembro
Low&raquo_space; molecular
- BRAF
- HER2

Question 7

Third line colon adenocarcinoma

Answer 7

Lonsurf
Regorafenib

Question 8

Define adjuvant therapy for colon CA based on T and N status

Answer 8

T1-3, N0 - Stage IIA - none
T4 N0 - stage IIB/C - 5FU/ leucovorin
Tx N1 - stage III - 6m FOLFOX / CAPOX

Question 9

What stage II CRC doesn’t get ADJ tx? (3)

Answer 9

• patient preference
• T1-3
• MSI HIGH

Question 10

Surface markers for GIST

Answer 10

cKIT (CD117) / DOG1

Question 11

Staying for GIST requires….

Answer 11

• size
• location
• mitoses / 50HPF
• Nodes

Question 12

What is the implication of node positive GIST

Answer 12

Metastatic/ stage 4 disease

Question 13

Role for adjuvant TKI in GIST

Answer 13

high risk patients (5cm AND high motoring rate)

Tx with three years of therapy

Question 14

Subsequent therapies in GIST

Answer 14

Sunitinib
Regorafinib
Ripretinib

Question 15

Mutation that confers Imari in resistance in GIST

Answer 15

PDGFRA D842V (exon 18)

Question 16

Treatment of non canonical GIST (cKit and PDGFRA negative)

Answer 16

Sunitinib

Question 17

Pancreatic CA germline testing

Answer 17

• BRCA
• PALB2
• ATM
• STK11
• MLH1/2 MSH6
• CDNK2D

Question 18

HPV variant with Anal SCC

Answer 18

HPV 16

Question 19

Tx for non metastatic Anal SCC

Answer 19

CRT
- 5FU CIV 1-4,29-32
- mitomycin 1,29
RT
-50-54Gy
-42-45 fx

Question 20

CholangioCA adjuvant tx

Answer 20

Cape

Question 21

Tx for unresectable CholangioCA

Answer 21

Durva - gem-cis up to 8 cycles

Question 22

All CholangioCA should be tested for

Answer 22

1 - IDH1 and FGFR2
2- full foundation panel given rare NTRK RET TMB HER2 etc

Question 23

HCC criteria for transplant

Answer 23

AFP< 1000
AND
one tumors <5cm
Or
3 tumors <3cm

Question 24

First line unresectable HCC tx (3)

Answer 24

• atezo bev
• treme durva
• sorafinib (contra indication for checkpoint)

Question 25

Second like HCC

Answer 25

• Cabo / lenvatinib / regorafinib

Question 26

RAPIDO trial findings

Answer 26

TMT with short course and long course CRT has similar OS but short course RT has less recurrent disease st 3 years