CME Post-Test

To earn CME credit online, please follow the instructions below:

If you are new to the Internet-based Studies in Education and Research (ISER) website, you will first need to create an account:

Step 1. Create an Account

https://www.hsconnect.pitt.edu/HSC/home/create-account.do

If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:

Step 2. Access the CME activity:

Gastrointestinal Cancer Research - Selected Proceedings and Abstracts from the 11th Annual Conference

https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=15253

FOR EACH QUESTION, CHOOSE THE CORECT ANSWER FROM THE MULTIPLE-CHOICE LIST.

1. Which of the following statements is false regarding Forkhead box P3 (FOXP3) isoforms and hepatocellular carcinoma (HCC)?

   1. HCC cells overexpress full-length FoxP3(FL) and variant isoforms Foxp3E2 and Foxp3E7.
   2. All three FoxP3 isoforms are functional in terms of their ability to inhibit tumor cell proliferation.
   3. The inhibitory effect of Foxp3FL was the strongest.
   4. The inhibitory effect of Foxp3E7 was the weakest.
2. Which of the following statements regarding pancreatic cancer is false?

   1. FOLFOX-A has substantial activity, is well tolerated, and represents a promising treatment for pancreatic cancer.
   2. A retrospective chart review of 56 pancreas cancer patients who underwent Whipple procedure demonstrated that adjuvant CT given after surgery offered a statistically significant 3-month improvement in DFS vs. adjuvant CRT.
   3. Gemcitabine monotherapy after surgery improves both overall survival and disease-free survival in patients with pancreatic cancer.
   4. Gemcitabine plus nab-P demonstrated superior efficacy over gemcitabine alone in a phase-III trial of patients with metastatic pancreatic cancer, including the primary end point of overall survival.
3. Which of the following statements about pancreatic neuroendocrine tumors (pNets) is incorrect?

   1. Everolimus demonstrated the longest overall survival yet reported in a phase-III study of patients with progressive advanced pNET.
   2. Surgical insult drives NET cells into active synthetic phase where they begin to express biomarkers specific to their tumor cells, which could guide further therapy.
   3. Pancreatic neuroendocrine tumors are rare functional neoplasms that produce a symptomatic syndrome as a result of hormones such as insulin, gastrin, glucagon, and vasoactive intestinal peptide (VIP) or others.
   4. Intraoperative application of chemotherapy is a safe and effective adjuvant for eliminating any potential microscopic residual disease after extensive cytoreductive surgeries in advanced-stage NET patients with mesenteric lymph node metastasis.
4. Which of the following statements concerning localized colorectal cancer is true?

   1. The optimal duration of adjuvant FOLFOX therapy for patients with stage-III colon cancer after curative-intent surgery is 6 months.
   2. The optimal duration of adjuvant oxaliplatin-based adjuvant therapy for patients with stage-III colon cancer after curative-intent surgery is 3 months.
   3. The standard adjuvant therapy for transmural and/or node-positive rectal cancer is the combination of pelvic irradiation with 5-FU–based chemotherapy.
   4. Adding concurrent chemotherapy to neoadjuvant radiotherapy increases pathological complete response in rectal cancer, and down-staging occurs in about 40% of patients.
5. Regarding immunotherapy of gastrointestinal malignancies, which of the following statements is incorrect?

   1. In hepatocellular carcinoma, multicentric disease occurs in 20%–60% of patients and is associated with continuous bacterial infection and chronic inflammation.
   2. Gastric cancer is frequently associated with H. Pylori infection, which induces infiltration of T-cells, B-cells, macrophages, and neutrophils.
   3. Gastrointestinal tumors may be targeted by an augmented immune response with clinical benefit in a subset of patients.
   4. Early results with Tremelimumab and Nivolumab have been encouraging enough to urge continued development of immunotherapy.
6. Which of the following general statements about colorectal cancer is incorrect?

   1. Angiogenesis inhibition is a known inducer of autophagy in tumor cells, allowing them to survive metabolic stress and potentially limit the therapeutic activity of chemotherapy and bevacizumab.
   2. After surgery, angiogenic factors are overexpressed in colorectal cancer where adjuvant treatment eradicates CRC cells but not the cancer stem cells, which are resistant to conventional anticancer treatment and cause deadly metastasis.
   3. Induction of an innate cancer cellular stress response caused by conventional chemotherapy enhances the expression of GRP78, which blocks apoptosis, increasing tumor growth and metastasis due to enhanced angiogenesis in CRC cells.
   4. Metastasis only to bone without other organ involvement in colorectal cancer is not uncommon.
7. Which of the following statements regarding antiangiogenesis therapy in colorectal cancer is correct?

   1. Metastatic CRC cells may develop resistance to bevacizumab via increased levels of placental growth factor (PlGF) and basic fibroblast growth factor (bFGF).
   2. In patients who had undergone prior treatment with bevacizumab, the addition of ziv-aflibercept to second-line FOLFIRI resulted in some improvement in PFS and OS, but statistical significance was not achieved for either end point.
   3. The addition of small molecule tyrosine kinase inhibitors against VEGFR to cytotoxic chemotherapy has recently demonstrated efficacy.
   4. Results of recent trials that have investigated monotherapy with tyrosine kinase inhibitors for multidrug refractory mCRC have so far proved disappointing.
8. Which of the following statements on emerging therapies for metastatic colorectal cancer is false?

   1. Mutation in BRAF codon 600 is a poor prognostic biomarker.
   2. Activating mutations in KRAS or NRAS are predictive biomarkers of resistance to the anti-EGFR antibodies.
   3. Activation of TLR9, a member of the toll-like receptor (TLR) family, on plasmacytoid dendritic cells and B cells may provoke innate and acquired immune responses against tumor cells.
   4. CRCs with MSI-H have a high frequency of frame-shift mutations, are associated with a lower number of tumor-infiltrating lymphocytes, and thus may be less likely to respond to immunotherapy.
9. Which of the following statements about the detection of circulating free (cf)DNA and circulating tumor cells (CTCs) in cancer patients is false?

   1. The detection of cfDNA can be informative of the biological and molecular characteristics of individual tumors.
   2. cfDNA is found in healthy persons; however, levels are significantly lower than those found in cancer patients.
   3. CTCs can be informative of the primary biopsy and prognostic of progression-free survival and overall survival in patients with metastatic colorectal cancer.
   4. Approved clinical assays are now available for characterizing cfDNA and CTCs.
10. “Liquid biopsy”—via analysis of circulating nucleic acids in peripheral blood—is currently under clinical investigation. Which of the following statements about liquid biopsy is false?

    1. Liquid biopsy embraces circulating DNA fragments carrying tumor-specific sequence alterations that can also be defined as cfDNA or circulating tumor (ct)DNA, as well as circulating CTCs.
    2. Liquid biopsy of cfDNA in plasma permits analysis of DNA, RNA, mRNA, and microRNA (miRNA).
    3. Tumor heterogeneity, one of the greatest limitations of tissue biopsies, could be assessed by analysis of circulating cancer cells in peripheral blood.
    4. The replacement of tissue biopsy with liquid biopsy is feasible and should be considered in the clinic.