POWER-PAK C.E. - Continuing Education for Pharmacists and Pharmacy Technicians


Evaluation Questions

1. Use the following CASE to answer questions 1 through 3.
WM is a 62-year-old male with advanced hepatocellular carcinoma (aHCC) who was recently treated with sorafenib monotherapy. At the time of diagnosis, WM had Child Pugh Class A liver function with an alpha fetoprotein (AFP) level of 97 ng/mL. His past medical history is significant for type 2 diabetes mellitus, cirrhosis, and uncontrolled hypertension secondary to sorafenib treatment. His oncologist would like to start him on second-line treatment at this time.

Which of the following is the most appropriate treatment for WM?

2. Which of the following is true regarding immune therapy for WM?

3. What should WM be told to expect regarding this treatment?

4. Use the following CASE to answer questions 4 and 5.
CD is a 67-year-old male with advanced hepatocellular carcinoma previously treated with lenvatinib 8 mg by mouth daily. He has a past medical history significant for uncontrolled type II diabetes mellitus, hepatitis C virus infection, and gastroesophageal reflux disease. Baseline labs show an alpha fetoprotein (AFP) level of 478 ng/mL. His total bilirubin is 1.6 mg/dL, international normalized ratio is 1.2, and albumin is 3.6 g/dL; he has no encephalopathy or ascites. Upon exam, CD mentions that he is unable to pay for or regularly take his lenvatinib, which likely explains his disease progression.

Which of the following systemic treatment options is most appropriate for CD at this time?

5. Which of the following is the correct dosing and frequency of ramucirumab?

6. Use the following CASE to answer questions 6 through 8.
MD is a 53-year-old African American male with unresectable hepatocellular carcinoma (HCC) who is taking lenvatinib 12 mg by mouth daily. Recent labs show a significant increase in total bilirubin, and computed tomography scans reveal disease progression. His oncologist discusses the treatment options with him, and they decide to enroll MD in a clinical trial of atezolizumab plus bevacizumab.

Which targets support the rationale for studying this combination regimen in HCC?

7. MD is found to have significant diarrhea during his treatment and is determined to have moderate (grade 2) colitis. Further evaluation is completed and rules out infectious etiologies. What is the appropriate treatment for MD?

8. After 3 days, MD has not shown a response to methylprednisolone. What is the best next step?

9. Use the following CASE to answer questions 9 and 10.
HT is a 63-year-old white male with advanced hepatocellular carcinoma currently enrolled in the HIMALAYA study. He is receiving treatment with durvalumab and tremelimumab. He calls his oncologist’s office and reports that he is experiencing some skin irritation.

What needs to be assessed in order to manage HT's signs and symptoms?

10. After the patient is seen in the same-day clinic, it is determined that he has grade 2 pruritus. How should HT be treated?

11. How confident are you in your decision about treatment for WM in the questions above?

12. How confident are you in your decision about treatment for CD in the questions above?

13. How confident are you in your decision about treatment for MD in the questions above?

14. How confident are you in your decision about treatment for HT in the questions above?


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