AOCNP Immunotherapy and Targeted Therapy 4 — Questions and Answers
Question 1: A patient on pembrolizumab develops grade 3 immune-mediated hepatitis (AST 8x ULN). What is the most appropriate management?
- Continue pembrolizumab with dose reduction
- Hold pembrolizumab and start high-dose corticosteroids (1–2 mg/kg prednisone) (Correct answer)
- Permanently discontinue pembrolizumab and initiate supportive care only
- Switch to a different PD-1 inhibitor immediately
Correct answer: Hold pembrolizumab and start high-dose corticosteroids (1–2 mg/kg prednisone)
Grade 3 immune-mediated hepatitis requires holding the checkpoint inhibitor and starting systemic corticosteroids at 1–2 mg/kg/day prednisone equivalent.
Question 2: Which biomarker is most predictive of response to olaparib in ovarian cancer?
- KRAS mutation
- BRCA1/2 mutation (Correct answer)
- PD-L1 expression
- HER2 amplification
Correct answer: BRCA1/2 mutation
Olaparib is a PARP inhibitor with the strongest efficacy evidence in BRCA1/2-mutated ovarian cancer due to synthetic lethality.
Question 3: A patient receiving nivolumab reports new-onset shortness of breath and ground-glass opacities on CT. Which immune-related adverse event is most likely?
- Immune-mediated colitis
- Immune-mediated pneumonitis (Correct answer)
- Immune-mediated myocarditis
- Immune-mediated nephritis
Correct answer: Immune-mediated pneumonitis
New respiratory symptoms with ground-glass opacities on CT in a patient on a checkpoint inhibitor are classic for immune-mediated pneumonitis.
Question 4: Venetoclax targets which anti-apoptotic protein overexpressed in CLL?
- MCL-1
- BCL-XL
- BCL-2 (Correct answer)
- XIAP
Correct answer: BCL-2
Venetoclax is a selective BCL-2 inhibitor that restores apoptosis in CLL cells that overexpress this anti-apoptotic protein.
Question 5: A nurse practitioner is counseling a patient starting erlotinib for EGFR-mutant NSCLC about the most common side effect. Which should be emphasized?
- Cardiotoxicity and QT prolongation
- Acneiform rash and diarrhea (Correct answer)
- Peripheral neuropathy and alopecia
- Myelosuppression and febrile neutropenia
Correct answer: Acneiform rash and diarrhea
Acneiform rash and diarrhea are the most common side effects of EGFR tyrosine kinase inhibitors such as erlotinib.
Question 6: Which mechanism best describes how CAR-T cell therapy targets tumor cells?
- Blocking PD-1/PD-L1 interaction to restore T-cell function
- Genetically engineering T cells with receptors that bind tumor antigens independent of MHC (Correct answer)
- Inhibiting VEGF to reduce tumor angiogenesis
- Delivering cytotoxic payloads via antibody-drug conjugates
Correct answer: Genetically engineering T cells with receptors that bind tumor antigens independent of MHC
CAR-T cells are engineered with chimeric antigen receptors that recognize tumor-associated antigens directly, bypassing MHC restriction.
Question 7: Cytokine release syndrome (CRS) after CAR-T cell infusion is most effectively treated in severe cases with which agent?
- High-dose methotrexate
- Tocilizumab (IL-6 receptor antagonist) (Correct answer)
- Rituximab
- Cyclophosphamide
Correct answer: Tocilizumab (IL-6 receptor antagonist)
Tocilizumab, an IL-6 receptor antagonist, is the first-line treatment for severe CRS because IL-6 is the primary cytokine driving this toxicity.
AOCNP Immunotherapy and Targeted Therapy 4
A patient on pembrolizumab develops grade 3 immune-mediated hepatitis (AST 8x ULN).
What is the most appropriate management?