American Board of Internal Medicine (ABIM) Certification Practice Exam

Which mutations are routinely evaluated in metastatic adenocarcinoma of the lung?

1. EGFR, KRAS, and P53

2. EML4/ALK, BRAF, and ROS1

3. EGFR, EML4/ALK, and ROS1

4. TP53, MYC, and HER2

The correct answer is: EGFR, EML4/ALK, and ROS1

In the context of metastatic adenocarcinoma of the lung, the evaluation of specific mutations is critical for determining targeted therapies. The correct choice highlights the mutations that have been most extensively studied for their implications in treatment. The presence of EGFR mutations is particularly significant as they often indicate sensitivity to EGFR inhibitors such as osimertinib and erlotinib. These targeted therapies have been shown to improve outcomes in patients with these specific alterations. EML4/ALK fusions are another important target in lung adenocarcinoma, as they lead to a specific form of malignancy that responds well to ALK inhibitors like crizotinib and alectinib. ROS1 rearrangements also represent a distinct subset of lung cancers that can be effectively treated with ROS1 inhibitors. Collectively, these three biomarkers—EGFR, EML4/ALK, and ROS1—enable personalized treatment strategies that enhance the likelihood of positive clinical responses in patients with metastatic adenocarcinoma of the lung. Routine testing for these mutations is standard practice in modern oncology, focusing on therapies that target the unique characteristics of the tumor, thereby improving patient management and outcomes. The other options present either less common mutations or those not typically evaluated as part of the first