OCC Targeted Therapy & Immunotherapy in Oncology 3

Question 1

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

Accepted Answer

Holding the checkpoint inhibitor and initiating systemic corticosteroids

Answer

Dose reduction by 50% and close monitoring

Answer

Antihistamines and acetaminophen for symptomatic relief

Answer

Colony-stimulating factors to support immune recovery

Question 2

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

Accepted Answer

A pharmacodynamic marker associated with tumor response and survival benefit

Answer

Anaphylaxis requiring immediate drug discontinuation

Answer

Disease progression unrelated to therapy

Answer

Bacterial superinfection requiring systemic antibiotics

Question 3

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

Accepted Answer

Multikinase inhibitors targeting VEGFR (sorafenib, sunitinib)

Answer

CDK 4/6 inhibitors (palbociclib, ribociclib)

Answer

Anti-PD-1 monoclonal antibodies (pembrolizumab, nivolumab)

Answer

Proteasome inhibitors (bortezomib, carfilzomib)

Question 4

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

Accepted Answer

Infliximab (anti-TNF monoclonal antibody)

Answer

Dose escalation of the checkpoint inhibitor

Answer

High-dose methotrexate immunosuppression

Answer

Emergency surgical colectomy as the only option

Question 5

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:

Accepted Answer

Tocilizumab (anti-IL-6 receptor antibody)

Answer

High-dose methylprednisolone 2 mg/kg IV

Answer

Epinephrine 0.3 mg IM for presumed anaphylaxis

Answer

Plasmapheresis to remove circulating cytokines

Question 6

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

Accepted Answer

Elevated TSH with low free T4

Answer

Hyperkalemia with hyponatremia (adrenal pattern)

Answer

Elevated LH and FSH with low estrogen

Answer

Low cortisol with elevated ACTH (pituitary pattern)

Question 7

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

Accepted Answer

Initiate antihypertensive therapy and continue sunitinib with close monitoring

Answer

Permanently discontinue sunitinib immediately

Answer

Reduce sunitinib dose by 75% without antihypertensive medication

Answer

Switch to bevacizumab, which has no cardiovascular risk