AOCNP Immunotherapy and Targeted Therapy

Question 1

Which class of immunotherapy works by blocking the PD-1/PD-L1 checkpoint pathway to restore anti-tumor T-cell activity?

Accepted Answer

Checkpoint inhibitors

Answer

Checkpoint inhibitors such as pembrolizumab (anti-PD-1), nivolumab (anti-PD-1), and atezolizumab (anti-PD-L1) block inhibitory signals that tumor cells use to suppress T-cell activity, thereby restoring the immune system's ability to recognize and destroy cancer cells.

Question 2

Imatinib (Gleevec) is a tyrosine kinase inhibitor (TKI) that targets which molecular abnormality in chronic myelogenous leukemia (CML)?

Accepted Answer

BCR-ABL fusion protein

Answer

Imatinib specifically inhibits the BCR-ABL tyrosine kinase produced by the Philadelphia chromosome (t(9;22) translocation) in CML. It was the first targeted therapy to demonstrate that molecular targeting of a cancer driver mutation could produce durable remissions.

Question 3

A patient receiving pembrolizumab develops severe, grade 3 immune-related pneumonitis. What is the most appropriate initial management?

Accepted Answer

Permanently discontinue pembrolizumab and start high-dose corticosteroids

Answer

Grade 3–4 immune-related pneumonitis requires permanent discontinuation of the checkpoint inhibitor and initiation of high-dose systemic corticosteroids (prednisone 1–2 mg/kg/day or methylprednisolone IV), with pulmonology consultation. This is a potentially life-threatening irAE.

Question 4

Which biomarker must be tested before initiating trastuzumab (Herceptin) therapy for breast cancer?

Accepted Answer

HER2 overexpression or gene amplification

Answer

Trastuzumab targets the HER2 (human epidermal growth factor receptor 2) protein. HER2 testing by IHC (3+ overexpression) and/or FISH/ISH (gene amplification) is mandatory before initiating trastuzumab, as it is only effective in HER2-positive tumors (~15–20% of breast cancers).

Question 5

Cytokine release syndrome (CRS) is a potentially life-threatening toxicity most commonly associated with which type of immunotherapy?

Accepted Answer

CAR-T cell therapy and bispecific T-cell engagers

Answer

CRS occurs when large numbers of immune cells are activated and release excessive cytokines (especially IL-6, IFN-γ), causing fever, hypotension, and hypoxia. It is most severe with CAR-T therapies (e.g., tisagenlecleucel) and bispecific T-cell engagers (e.g., blinatumomab). Tocilizumab is the treatment of choice for severe CRS.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Immunotherapy and Targeted Therapy