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1. BJ, a 64-year-old male, is diagnosed with stage IV clear cell renal cell carcinoma (RCC). His current Karnofsky performance status is 75% and his complete metabolic panel is within normal limits. His complete blood counts are within normal limits other than an elevated neutrophil count of 9.8 10⁹/L. Which risk category is the most appropriate for BJ?

A. Favorable-risk disease per IMDC prognostic criteria B. Intermediate-risk disease per IMDC prognostic criteria C. Poor-risk disease per MSKCC prognostic model D. Intermediate-risk disease per MSKCC prognostic model E. Unsure

2. Which of the following is a key finding between the combinations pembrolizumab/axitinib and avelumab/axitinib vs sunitinib that was demonstrated in the Keynote-426 trial and JAVELIN Renal 101 trials, respectively?

A. Both regimens demonstrated an overall survival benefit over sunitinib monotherapy regardless of PD-L1 expression B. Patients with favorable-risk disease had improved survival on sunitinib monotherapy C. Any grade treatment-related adverse events were significantly higher with combination therapy D. Avelumab/axitinib overall survival benefit in the intent-to-treat population is not yet reached E. Unsure

3. As the oncology EMR IT pharmacist at your institution, you are asked to build treatment plans for the newly approved pembrolizumab/axitinib and avelumab/axitinib regimens for advanced RCC. Which of the following should be in place to ensure optimal management of patients receiving therapy?

A. PD-L1 expression testing prior to therapy initiation for both regimens B. Pembrolizumab and avelumab continue through cycle 4 and then axitinib maintenance until disease progression or toxicity C. Baseline EKG monitoring, every 3 months thereafter for 1 year, then as clinically appropriate D. Communication to assess ability to increase axitinib dose to 7 mg and 10 mg BID E. Unsure

4. MJ was recently initiated on ipilimumab/nivolumab for advanced RCC. She presents to your clinic for follow up and initiation of cycle 2, and it is noted she is experiencing a mild skin reaction that does not bother her (<10% of body surface; grade 1). She denies pruritus or any other symptoms. Which of the following is the most appropriate management?

A. Discontinue ipilimumab/nivolumab and initiate prednisone 1 to 2 mg/kg/day B. Continue ipilimumab/nivolumab and initiate topical triamcinolone cream BID – TID C. Continue ipilimumab/nivolumab and initiate infliximab 5 mg/kg once every 2 weeks D. Switch from ipilimumab/nivolumab to sunitinib E. Unsure

5. BH is initiating therapy with sunitinib for metastatic renal cell carcinoma. His past medical history is significant for hypothyroidism, hypertension, hyperlipidemia, and epilepsy—all of which are well controlled on levothyroxine, lisinopril, atorvastatin, and levetiracetam. Which of the following should be discussed with BH?

A. The need for weekly TSH and free T4 labs during the first month of therapy B. The need for biweekly lipid panels during the first two months of therapy C. The need for a blood pressure monitoring device for daily blood pressure checks D. The need to increase his sunitinib dose due to an interaction with levetiracetam E. Unsure

6. JG, a 61-year-old male, presents to the clinic for cycle 2 day 15 of avelumab/axitinib therapy for metastatic RCC. As the oncology pharmacist, you receive a call from the infusion nurse stating that JG reports having 2 to 3 episodes of diarrhea per day over the past 3 days (grade 1) and whether his infusion should be held. Which of the following is the most appropriate recommendation?

A. Hold avelumab and initiate loperamide 4 mg after first loose stool followed by 2 mg with subsequent episodes B. Hold avelumab and initiate prednisone 1 to 2 mg/kg/day followed by a long taper upon resolution of diarrhea C. Continue avelumab/axitinib and initiate loperamide 4 mg after first loose stool followed by 2 mg with subsequent episodes D. Hold avelumab/axitinib and initiate prednisone 1 to 2 mg/kg/day and loperamide 4 mg after first loose stool followed by 2 mg with subsequent episodes E. Unsure

7. Which of the following immunotherapies is approved as adjuvant treatment for patients with localized RCC?

A. Nivolumab B. Pembrolizumab C. Atezolizumab D. Avelumab E. Unsure

8. Which of the following adverse events may be shared between IO therapy and VEGF therapies?

A. Endocrinopathies and diarrhea B. Diarrhea and hypertension C. Hypertension and proteinuria D. Unsure

9. BK has recently initiated therapy with cabozantinib + nivolumab for advanced RCC. After 3 cycles of therapy, he reports more fatigue and lethargy than normal, dry skin, and hair thinning. Which of the following would be the most appropriate intervention at this time?

A. Hold therapy and initiate prednisone 0.5 to 1 mg/kg/day B. Evaluate thyroid function and initiate levothyroxine as appropriate C. Continue therapy and initiate topical corticosteroids D. Hold therapy and initiate infliximab 5 mg/kg once E. Unsure

10. AD, a 63-year-old male, was initially treated with pembrolizumab + axitinib for intermediate risk, stage IV RCC. After 7 months of therapy, he presents to his oncologist and is found to have disease progression. Which of the following would be an appropriate second-line therapy for AD?

A. Avelumab + axitinib B. Sunitinib C. Interferon D. Ipilimumab/nivolumab E. Unsure

Maintenance is scheduled for 08/28/2024 6:00 AM EST - 08/28/2024 5:00 PM EST.

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2. Which of the following is a key finding between the combinations pembrolizumab/axitinib and avelumab/axitinib vs sunitinib that was demonstrated in the Keynote-426 trial and JAVELIN Renal 101 trials, respectively?

3. As the oncology EMR IT pharmacist at your institution, you are asked to build treatment plans for the newly approved pembrolizumab/axitinib and avelumab/axitinib regimens for advanced RCC. Which of the following should be in place to ensure optimal management of patients receiving therapy?

7. Which of the following immunotherapies is approved as adjuvant treatment for patients with localized RCC?

8. Which of the following adverse events may be shared between IO therapy and VEGF therapies?

9. BK has recently initiated therapy with cabozantinib + nivolumab for advanced RCC. After 3 cycles of therapy, he reports more fatigue and lethargy than normal, dry skin, and hair thinning. Which of the following would be the most appropriate intervention at this time?

10. AD, a 63-year-old male, was initially treated with pembrolizumab + axitinib for intermediate risk, stage IV RCC. After 7 months of therapy, he presents to his oncologist and is found to have disease progression. Which of the following would be an appropriate second-line therapy for AD?

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Maintenance is scheduled for 08/28/2024 6:00 AM EST - 08/28/2024 5:00 PM EST.

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2. Which of the following is a key finding between the combinations pembrolizumab/axitinib and avelumab/axitinib vs sunitinib that was demonstrated in the Keynote-426 trial and JAVELIN Renal 101 trials, respectively?

3. As the oncology EMR IT pharmacist at your institution, you are asked to build treatment plans for the newly approved pembrolizumab/axitinib and avelumab/axitinib regimens for advanced RCC. Which of the following should be in place to ensure optimal management of patients receiving therapy?

7. Which of the following immunotherapies is approved as adjuvant treatment for patients with localized RCC?

8. Which of the following adverse events may be shared between IO therapy and VEGF therapies?

9. BK has recently initiated therapy with cabozantinib + nivolumab for advanced RCC. After 3 cycles of therapy, he reports more fatigue and lethargy than normal, dry skin, and hair thinning. Which of the following would be the most appropriate intervention at this time?

10. AD, a 63-year-old male, was initially treated with pembrolizumab + axitinib for intermediate risk, stage IV RCC. After 7 months of therapy, he presents to his oncologist and is found to have disease progression. Which of the following would be an appropriate second-line therapy for AD?

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