Respiratory medicine: lung cancer targeted therapy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: lung cancer targeted therapy

Sample item

A 58-year-old woman who has never smoked is diagnosed with stage IV lung adenocarcinoma. Molecular testing of the tumour shows an EGFR exon 19 deletion. Which is the preferred first-line systemic treatment?

APembrolizumab aloneBCisplatin with etoposideCAn EGFR tyrosine kinase inhibitor such as osimertinibDCrizotinib

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. An EGFR tyrosine kinase inhibitor such as osimertinib

Adenocarcinomas in never-smokers, particularly Asian women, often carry activating EGFR mutations that make the tumour dependent on EGFR signalling. EGFR tyrosine kinase inhibitors give higher response rates and longer progression-free survival than chemotherapy. Testing for EGFR, ALK, ROS1 and PD-L1 should be done before treatment is chosen.

Option by option

A. Pembrolizumab alone
Immunotherapy alone works poorly in EGFR-mutant tumours, which are largely resistant to it.
B. Cisplatin with etoposide
Cisplatin with etoposide is the standard regimen for small cell lung cancer.
C. An EGFR tyrosine kinase inhibitor such as osimertinib (correct)
Correct. An EGFR inhibitor targets the driver mutation and is the standard first-line choice.
D. Crizotinib
Crizotinib inhibits ALK and ROS1 rearrangements, which this tumour does not have.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, An EGFR tyrosine kinase inhibitor such as osimertinib. Adenocarcinomas in never-smokers, particularly Asian women, often carry activating EGFR mutations that make the tumour dependent on EGFR signalling.

Why is "Pembrolizumab alone" not the answer?

Immunotherapy alone works poorly in EGFR-mutant tumours, which are largely resistant to it.

Why is "Cisplatin with etoposide" not the answer?

Cisplatin with etoposide is the standard regimen for small cell lung cancer.

Why is "Crizotinib" not the answer?

Crizotinib inhibits ALK and ROS1 rearrangements, which this tumour does not have.

What concept does this question test?

It tests Respiratory medicine: lung cancer targeted therapy in General Medicine. EGFR tyrosine kinase inhibitors give higher response rates and longer progression-free survival than chemotherapy. Testing for EGFR, ALK, ROS1 and PD-L1 should be done before treatment is chosen.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: lung cancer targeted therapy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.