Game On Chicago Pre-Assessment

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to reflects 56-year-old

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1. Your 68-year-old patient with newly diagnosed metastatic NSCLC has significant cardiopulmonary comorbidities that make repeat tissue sampling unsafe. Which of the following statements best reflects current evidence and guideline-informed practice regarding the use of liquid biopsy in this scenario?

a) Liquid biopsy is appropriate as an adjunct in this patient and may better capture tumor heterogeneity, while recognizing that false-negative results may occur due to lower sensitivity.
b) Liquid biopsy is not recommended because plasma ctDNA testing cannot detect minimal residual disease and offers no advantages for longitudinal assessment.
c) Liquid biopsy is unlikely to provide useful information because poor standardization means that ctDNA assays are unable to detect clinically relevant genomic alterations in metastatic NSCLC.
d) Liquid biopsy should replace tissue biopsy as the method for biomarker detection because it has higher sensitivity and superior ability to detect all actionable driver alterations.

1b. Please select the extent to which you feel confident in your answer

A. Completely confident	B. Fairly confident	C. Somewhat confident	D. Slightly confident	E. Not confident
A. Completely confidentA. Completely confident	B. Fairly confidentB. Fairly confident	C. Somewhat confidentC. Somewhat confident	D. Slightly confidentD. Slightly confident	E. Not confidentE. Not confident

2. Consider your 56-year-old patient, a never-smoking woman who is diagnosed with metastatic lung adenocarcinoma. Initial next-generation sequencing (NGS) identifies an ERBB2 exon 20 insertion. Which of the following is the most appropriate interpretation to guide your diagnostic and therapeutic decision-making in this case?

a) Amplification of HER2 in NSCLC shows consistent epidemiologic patterns across populations, so detection of amplification in a non-smoking woman would be unexpected and should prompt repeat testing.
b) Exon 20 insertions are strongly correlated with HER2 amplification, so confirming amplification is essential to determine whether HER2 overexpression is likely to be present.
c) HER2 alterations in NSCLC represent biologically distinct entities; therefore, HER2 amplification and protein overexpression cannot be assumed based on the presence of a HER2 mutation, and each alteration requires separate testing if clinically relevant.
d) HER2 protein overexpression detection by immunohistochemistry is the most reliable surrogate for HER2 mutation status in NSCLC and should be prioritized to confirm the NGS finding.

2b. Please select the extent to which you feel confident in your answer

A. Completely confident	B. Fairly confident	C. Somewhat confident	D. Slightly confident	E. Not confident
A. Completely confidentA. Completely confident	B. Fairly confidentB. Fairly confident	C. Somewhat confidentC. Somewhat confident	D. Slightly confidentD. Slightly confident	E. Not confidentE. Not confident

3. Your 62-year-old patient with metastatic HER2-mutant NSCLC harboring an exon 20 insertion has progressed after platinum-based chemotherapy. Based on current evidence, which of the following statements best reflects the comparative efficacy of first-generation versus newer-generation HER2-directed TKIs in this setting?

a) Afatinib demonstrates clinically meaningful activity in HER2-mutant NSCLC, with ORR exceeding 30% in previously treated patients.
b) First-generation TKIs showed limited activity in HER2-mutant NSCLC, whereas the new-generation TKI sevabertinib has demonstrated markedly higher objective response rates.
c) Neratinib monotherapy has shown tumor responses in HER2-mutant NSCLC, with ORR above 20%.
d) The efficacy of sevabertinib appears restricted to patients previously treated with HER2-targeted antibody–drug conjugates, with little to no benefit in TKI-naïve patients.

3b. Please select the extent to which you feel confident in your answer

A. Completely confident	B. Fairly confident	C. Somewhat confident	D. Slightly confident	E. Not confident
A. Completely confidentA. Completely confident	B. Fairly confidentB. Fairly confident	C. Somewhat confidentC. Somewhat confident	D. Slightly confidentD. Slightly confident	E. Not confidentE. Not confident

4. Your 57-year-old patient with metastatic lung adenocarcinoma harboring a HER2 exon 20 YVMA insertion presents with new-onset headaches and gait instability. MRI of the brain shows multiple lesions. She previously received platinum-based chemotherapy with pemetrexed and has stable extracranial disease but symptomatic CNS progression. Based on the available evidence on HER2-mutant NSCLC, which of the following management strategies best demonstrates an evidence-based, personalized approach for this patient?

a) Consider enrollment in a clinical trial evaluating sevabertinib, given the high CNS disease burden and the YVMA subtype’s aggressive CNS behavior.
b) Continue current systemic therapy and treat only with local CNS therapy as HER2-mutant NSCLC rarely develops additional brain metastases after initial treatment.
c) Switch systemic therapy to afatinib as pan-HER TKIs have demonstrated consistent intracranial activity in HER2-mutant NSCLC.
d) Switch to dacomitinib as patients with the YVMA HER2 subtype have demonstrated improved outcomes with pan-HER TKIs compared to chemotherapy.

4b. Please select the extent to which you feel confident in your answer

A. Completely confident	B. Fairly confident	C. Somewhat confident	D. Slightly confident	E. Not confident
A. Completely confidentA. Completely confident	B. Fairly confidentB. Fairly confident	C. Somewhat confidentC. Somewhat confident	D. Slightly confidentD. Slightly confident	E. Not confidentE. Not confident

5. Which of the following statements best reflects current evidence regarding clinician- and patient-level barriers to effective communication in cancer care?

a) Barriers at the patient-level, such as cultural or religious beliefs, are less frequently reported than clinician-level factors and have a lower impact on communication quality.
b) Current evidence suggests that emotional distress primarily influences treatment decision-making rather than patient-clinician communication quality.
c) Lack of patient knowledge and limited language proficiency are the most consistently reported patient-level barriers, while clinician time limitations remain a significant barrier cited by both clinicians and patients.
d) Time constraints primarily affect patient education but do not significantly influence clinicians’ ability to identify poor prognosis or initiate serious illness conversations.

5b. Please select the extent to which you feel confident in your answer

A. Completely confident	B. Fairly confident	C. Somewhat confident	D. Slightly confident	E. Not confident
A. Completely confidentA. Completely confident	B. Fairly confidentB. Fairly confident	C. Somewhat confidentC. Somewhat confident	D. Slightly confidentD. Slightly confident	E. Not confidentE. Not confident

6. Your 56-year-old patient (the never-smoking woman) arrives for her treatment-planning visit. She appears anxious and says she is “getting different stories” from the care team and says she feels “talked down to” when she tries to ask questions. Which of the following actions would most effectively address the documented drivers of communication failure and strengthen shared decision-making for this patient?

a) Encourage the patient to bring a family member or caregiver to future visits to help ensure she is able to retain the information provided.
b) Focus the visit on reviewing the proposed treatment regimen in detail, emphasizing the evidence supporting each component to improve the patient’s confidence in the plan.
c) Reassure her that the clinical team is very experienced with HER2-mutated NSCLC and will guide her through the correct treatment steps.
d) Use communication skills that include eliciting her understanding of HER2-mutated NSCLC, validate her concerns about mixed messages, and coordinate unified messaging across the oncology team.

6b. Please select the extent to which you feel confident in your answer

A. Completely confident	B. Fairly confident	C. Somewhat confident	D. Slightly confident	E. Not confident
A. Completely confidentA. Completely confident	B. Fairly confidentB. Fairly confident	C. Somewhat confidentC. Somewhat confident	D. Slightly confidentD. Slightly confident	E. Not confidentE. Not confident

7. How confident are you in your ability to evaluate clinical evidence on emerging therapeutic options for HER2-mutant NSCLC and create individualized treatment plans?