Immunotherapy and Targeted Therapy Flashcards

Which immune-related adverse event (irAE) is most commonly associated with anti-PD-1/PD-L1 therapy?

Answer: Hypothyroidism

Thyroid dysfunction (hypothyroidism more common than hyperthyroidism) is among the most frequent irAEs with anti-PD-1/PD-L1 therapy, occurring in 6–20% of patients. TSH monitoring is recommended at baseline and every 4–6 weeks during treatment.

Bispecific T-cell engager (BiTE) blinatumomab works by simultaneously binding which two targets?

Answer: CD3 on T cells and CD19 on B-cell tumors

Blinatumomab is a bispecific antibody that bridges CD3 (on cytotoxic T cells) and CD19 (on B-cell malignancies), directing T cells to kill leukemic B cells. It is approved for relapsed/refractory ALL and minimal residual disease (MRD)-positive B-cell ALL.

A patient with metastatic colorectal cancer has a KRAS wild-type, RAS/RAF wild-type tumor. Which targeted therapy is most appropriate?

Answer: Cetuximab or panitumumab (anti-EGFR)

Anti-EGFR monoclonal antibodies (cetuximab, panitumumab) are only effective in metastatic colorectal cancer patients with RAS/RAF wild-type tumors. KRAS mutations cause downstream EGFR-independent activation, rendering anti-EGFR therapy ineffective in mutant patients.

Which toxicity is specifically associated with VEGFR/multi-kinase inhibitors (sunitinib, sorafenib) and requires proactive management?

Answer: Hand-foot skin reaction (palmar-plantar erythrodysesthesia)

Hand-foot skin reaction (HFSR/PPE) is a class-specific toxicity of VEGFR TKIs characterized by painful erythema, blistering, and hyperkeratosis on palms and soles. Prevention includes skin moisturization, pressure-relief padding, dose reduction for grade 2–3, and avoidance of tight footwear.

Chimeric antigen receptor T-cell (CAR-T) therapy requires T cells to be genetically engineered to express a receptor targeting which antigen in most approved hematologic malignancy indications?

Answer: CD19 or BCMA

FDA-approved CAR-T products (axicabtagene ciloleucel, tisagenlecleucel, lisocabtagene maraleucel) target CD19 on B-cell malignancies (ALL, DLBCL, FL). BCMA-targeted CAR-T (idecabtagene vicleucel, ciltacabtagene autoleucel) is approved for multiple myeloma.

The ONCO NP is educating a patient beginning osimertinib. Which side effect is most important to monitor and manage proactively?

Answer: Dermatologic toxicity and QTc prolongation

Osimertinib commonly causes acneiform rash, dry skin, paronychia, and can cause QTc prolongation (interstitial lung disease is a rare but serious toxicity). Baseline and periodic ECG monitoring is recommended; dermatologic prophylaxis with topical antibiotics and emollients is standard practice.