Targeted Therapy & Immunotherapy in Oncology Flashcards

Moderate to severe immune-related adverse events (irAEs) from checkpoint inhibitors are primarily managed with:

Answer: Holding the checkpoint inhibitor and initiating systemic corticosteroids

Moderate to severe irAEs require holding the checkpoint inhibitor and initiating high-dose systemic corticosteroids (e.g., prednisone 1-2 mg/kg/day) to suppress aberrant immune activation.

A patient on cetuximab (EGFR inhibitor) develops a papulopustular acneiform rash. This finding most likely indicates:

Answer: A pharmacodynamic marker associated with tumor response and survival benefit

The acneiform/papulopustular rash from EGFR inhibitors is a recognized pharmacodynamic marker correlating with drug activity and is associated with improved tumor response and overall survival.

Hand-foot skin reaction (HFSR) with painful, thickened skin on palms and soles is a characteristic toxicity of which class?

Answer: Multikinase inhibitors targeting VEGFR (sorafenib, sunitinib)

HFSR is a class effect of VEGFR-targeting multikinase inhibitors (sorafenib, sunitinib, regorafenib, cabozantinib) due to disruption of skin repair mechanisms.

Grade 3-4 immune-related colitis that does not respond to high-dose corticosteroids should be treated with:

Answer: Infliximab (anti-TNF monoclonal antibody)

Infliximab, an anti-TNF antibody, is the recommended treatment for steroid-refractory immune-related colitis as it effectively suppresses TNF-mediated intestinal inflammation.

A patient receiving CAR-T cell therapy develops fever (39.5°C), hypotension, and hypoxia 18 hours post-infusion. First-line treatment for this severe cytokine release syndrome (CRS) is:

Answer: Tocilizumab (anti-IL-6 receptor antibody)

Tocilizumab, an anti-IL-6 receptor antibody, is the first-line treatment for severe CRS (grade ≥3) from CAR-T therapy, as IL-6 is the primary cytokine driving this syndrome.

Which laboratory pattern is most consistent with checkpoint inhibitor-induced immune-related thyroiditis progressing to hypothyroidism?

Answer: Elevated TSH with low free T4

Checkpoint inhibitor-induced thyroiditis most commonly results in hypothyroidism (elevated TSH, low free T4), which typically requires lifelong levothyroxine replacement.

A patient on a VEGFR tyrosine kinase inhibitor (sunitinib) develops new-onset hypertension. The most appropriate initial management is:

Answer: Initiate antihypertensive therapy and continue sunitinib with close monitoring

Hypertension from VEGFR TKIs is expected and manageable; initiating antihypertensive therapy (e.g., ACE inhibitors, calcium channel blockers) allows continuation of the targeted agent with blood pressure monitoring.