Molecular Diagnostic Cancer Biomarkers 2018 (Naab)

Question 1

Molecular tests for selective cancers

Answer 1

NCCN, CAP

Question 2

What are tested used for invasive breast cancer?

Answer 2

Nuclear Stains

• ER
• PR
• Ki-67 (a proliferative marker)

HER2 (which can be done by IHC or FISH

Question 3

KRAS/NRAS, Mismatch Repair testing for which cancer?

Answer 3

for colorectal carcinoma (CRC)

Question 4

What tests are used for gliomas?

Answer 4

IDH1, 1p/19q codeletion (FISH), MGMT methylation

Question 5

What oncogene is tested for in malignant melanoma?

Answer 5

BRAF for malignant melanoma

Question 6

What are mandated tests for in Nonsmall Cell Lung Carcinoma (NSCLC) adenocarcinoma?

Answer 6

EGFR, ALK, ROS1, BRAF, PDL1

No KRAS because no targeted therapy for it, as KRAS mutations are seen in smokers.

Question 7

BRCA1 andBRCA2gene mutationsmost common in what cancer? Most breast cancers are of what type?

Answer 7

breast

sporadic (85%)

Question 8

Colorectal cancer should be tested using what tests?

Answer 8

KRAS mutation prognostic: unfavorable poorer survival
poor prognosis due to lack of response to anti-EGFR therapy (cetuximab) (WT = Wild Type or nonmutated)

BRAF V600 for prognostic stratification

Mismatch repair status testing in all patients with CRC for identification of patients at high risk for Lynch syndrome and/or prognostic stratification

Question 9

In addition to blocking this receptor, you can upregulate T cells to attack the tumor as well. This is a two-prong effect for treating melanomas.

Combination of PD1 inhibitor with anti-CTLA-4 inhibitor has been used in melanoma

Answer 9

CTLA-4 signaling inhibits T-cell activation, particularly during strong T-cell responses.

CTLA-4 blockade results in direct activation of CD4+ and CD8+ effector cells

Downside
Immune related toxicity
and diarrhea in GI tract

Question 10

In addition to blocking this receptor, you can upregulate T cells to attack the tumor as well. This is a two-prong effect for treating melanomas.

Answer 10

CTLA-4 signaling inhibits T-cell activation, particularly during strong T-cell responses.

CTLA-4 blockade results in direct activation of CD4+ and CD8+ effector cells

Combination of PD1 inhibitor with anti-CTLA-4 inhibitor has been used in melanoma

Downside
Immune related toxicity
and diarrhea in GI tract

Question 11

What drug would you give to patients with higher tumors?

Answer 11

cetuximab

Question 12

Microsatelite instability in colorectal cancer is due to germline mutations in what?

Answer 12

mixmatch repair genes

Question 13

For women with breast cancer,
ER/PR positive
Low Ki-67
HER2 negative
Lymph nodes negative

are indicative of what prognosis?

Answer 13

Favorable prognosis

Question 14

For women with breast cancer,

ER/PR negative
High Ki-67 >14%
HER2 positive
Lymph nodes positive
Triple negative

are indicative of what prognosis?

Answer 14

Unfavorable prognosis

Question 15

• Occurs in 5 years younger
• non-smoker/non-drinkers
• located in the tonsil and tongue base
• NONKERATINIZING
• p53 inactivated by E6
• Rb inactivated by E7
• p16 OVER-expressed

Is HPV positive or negative in this description of present cancer?

Answer 15

HPV positive

Question 16

• Occurs in the typical ages
• tobacco and alcohol
• occurs in all locations
• KERATINIZING squamous cell carcinoma
• p53 inactivated by mutation
• Rb inactivated by cyclin D1 amplification
• inactivation of p16

Is HPV positive or negative in this description of present cancer?

Answer 16

HPV negative

Question 17

HBV and HCV both can cause what type of cancer?

Answer 17

hepatocellular carcinoma

Question 18

What is p53 deactivated by to cause head and neck cancer?

Answer 18

E6, an oncoprotein of HPV