1. Use the following CASE to answer questions 1 through 5:
AD is a 73-year-old white male with a history of chronic pancreatitis due to alcohol intake. He also has diabetes. After AD complained of severe back pain and upper abdominal pain, he underwent a computed tomography (CT) scan, which found a 3-cm mass in the head of the pancreas. Endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) have been done and the tumor is Stage 1B, which surgery has determined is resectable. An endoscopic retrograde cholangiopancreatography (ERCP) procedure confirmed the histology of pancreatic ductal adenocarcinoma. His organ function is within normal limits, and his Eastern Cooperative Oncology Group (ECOG) performance status is 1. His tumor is found to be mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) negative, breast cancer gene (BCRA) 1/2 negative, and neurotrophic tyrosine receptor kinase (NTRK) negative.

According to the information given, which therapy is most appropriate for AD for adjuvant therapy after surgery?

2. AD completed 6 months of adjuvant therapy with a complete response. However, about 18 months later, a lesion is detected near the surgical site and in the liver. Tissue biopsy confirms metastatic relapsed disease. ECOG status continues to be 1. As the pharmacist, what is your recommendation for front-line therapy?

3. The fellow wants to add pembrolizumab to the regimen you recommended. You instruct that fellow that the tumor needs a specific biomarker to recommend pembrolizumab. What is that biomarker?

4. AD has not done well on the therapy selected and the tumor continues to grow. The oncologist wants to use nanoliposomal irinotecan with 5-FU/leucovorin as second-line therapy. According to the results of the NAPOLI-1 trial, what is known about the overall survival (OS) and progression-free survival (PFS) of this regimen compared to 5-FU/leucovorin?

5. AD's disease continues to progress on second-line therapy with nanoliposomal irinotecan. Which of the following is the best option for AD for third-line therapy?

Evaluation Questions

6. How confident are in your treatment choice for AD in the previous questions:

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