1. Which of the following best describes the current first-line standard of care for extensive stage small cell lung cancer?
A. Pembrolizumab and axitinib
B. Nivolumab and ipilimumab
C. Atezolizumab, carboplatin, and etopside
D. Durvalumab and radiation
E. Unsure
2. Which of the following is true about the use of an immune checkpoint inhibitor in combination therapy regimen for first line small cell lung cancer?
A. The overall survival curve separates early in therapy, indicating that early immunotherapy use is imperative.
B. The overall survival curves separate after about 7 months, bringing into question the importance of using the immunotherapy with cycle 1.
C. Immunotherapy improves overall response rates and tumor caused symptoms, but does not change the median overall survival
D. It improves progression free survival, but not overall survival
E. Unsure
3. What best describes the place in therapy for atezolizumab in breast cancer?
A. It is used in the first line setting for metastatic triple negative breast cancer
B. It is used as adjunctive therapy in stage 2/3 hormone receptor positive breast cancer
C. The approved indication is for treatment of residual disease after neoadjuvant therapy and surgery in Her2+ and ER+ breast cancer
D. It is used after 12 months of adjuvant trastuzumab in HER2+ breast cancer
E. Unsure
4. Which of the following drugs is approved for cutaneous squamous cell carcinoma that is not resectable or amenable to radiation?
A. Nivolumab
B. Pembrolizumab
C. Durvaluamab
D. Cemiplimab-rwlc
E. Unsure
5. What best describes the role of immune checkpoint inhibitors in metastatic colorectal cancer?
A. Treatment is restricted to the adjuvant setting with atezolizumab
B. Pembrolizumab is the preferred first line therapy for MSI-H/dMMR metastatic colorectal cancer
C. Nivolumab and ipilimumab provides the highest response rate for MSI-H or dMMR mCRC who have failed oxaliplatin, fluorouracil, and irinotecan
D. Avelumab plus fluorouracil is preferred for elderly mCRC patients
E. Unsure
6. Which agent has accelerated approved to treat recurrent or metastatic cervical cancer after failing at least 1 chemotherapy regimen?
A. Nivolumab
B. Pembrolizumab
C. Avelumab
D. Durvalumab
E. Unsure
7. Why would a clinician choose nivolumab/ipilimumab instead of avelumab/axitinib for the first line treatment of metastatic renal cell carcinoma (currently discussed point of contention)?
A. The head to head study showed that nivolumab/ipilimumab was better (OS) than avelumab/axitinib
B. There is no rational to use nivolumab/ipilimumab first
C. After progression on first line nivolumab/ipilimumab, patients would still be VEGF therapy naïve, which could provide multiple therapy choices with a proven clinical benefit
D. Neither combination is used as first line therapy for metastatic renal cell carcinoma
E. Unsure
8. What best describes the utility of tumor PD-L1 expression?
A. It is always used to determine where or not a PD1i or PD-L1i should be used
B. Although it is generally prognostic, the negative predictive strength is too weak to exclude patients from treatment
C. It must be paired with circulating cytotoxic T-cells expressing PD1 (exhausted T-cells) to be of any value (both need to be high)
D. Is not as good as evaluating neoantigens on tumor cells, which is captured with tumor mutational burden.
E. Unsure
9. How do MSI-H/dMMR, tumor mutational burden, and neoantigens fit together to predict response to immune therapy?
A. High neoantigen expression is the product of mutated genes (high TMB), which is common with DNA defects like dMMR
B. They are independent variables that cumulative add to the predictive response to treatment with a PD1 or PD-L1
C. They do not predict response to immunotherapy because they are not measure in exhausted T-cells (targets of our ICIs)
D. They are only important in our hematological tumors that present antigens
E. Unsure
10. Which of the following does NOT influence the laboratory measurement of PD-L1 expression?
A. The testing platform and antibody
B. Tumor material (fresh, fixed, paraffin embedded)
C. Tumor type (Lung vs hepatic vs kidney)
D. Cells tested (infiltrating immune cells plus tumor cells vs only tumor cells)
E. Unsure
11. Which of the following is true when a grade 2 rash is seen during therapy with chemotherapy and immunotherapy, where multiple agents could be causing the toxicity?
A. All the drugs should be stopped permanently
B. Consider holding the drugs until improvement, then restart only the chemotherapy at a reduced dose
C. Consider holding the drugs until improvement, then restart only the immunotherapy at a reduced dose
D. Consider holding the drugs until improvement, then restart dose reduced chemotherapy and full dose immunotherapy
E. Unsure
