1. Which of the following is NOT considered a risk factor for small cell lung cancer (SCLC)?
A. Tobacco smoking
B. Radon exposure
C. Obesity
D. Prolonged exposure to secondhand smoke
E. Unsure
2. Use the following case to answer questions 2 and 3:
A. Cisplatin plus etoposide, possibly with thoracic radiation therapy
B. Gemcitabine plus paclitaxel
C. Cisplatin, etoposide, and atezolizumab
D. Trastuzumab monotherapy followed by thoracic radiation therapy
E. Unsure
3. Lobectomy during surgical resection indicated regional nodal involvement, so her oncologist considers the use of prophylactic cranial irradiation (PCI). What is the best option?
A. Administer PCI, regardless of response to initial therapy
B. Administer PCI only if patient has a good response to initial therapy
C. Wait until patient shows signs of brain metastases before initiating PCI
D. Do not administer PCI; PCI is not useful in this situation
E. Unsure
4. Use the following case to answer questions 4 through 6:
A. Maintenance immunotherapy for 3 cycles
B. Maintenance immunotherapy, continued until disease progression
C. No maintenance immunotherapy
D. Maintenance immunotherapy with low-dose chemotherapy
E. Unsure
5. Following relapse of ES-SCLC, options for second-line therapy are considered, including the use of immune checkpoint inhibitors. Before commencing such therapy, what pathology test should be performed to aid in predicting response to immunotherapy?
A. Genomic analysis of circulating tumor DNA (ctDNA)
B. Tumor PD-L1 expression
C. PD-1 staining of immune cells
D. No specific test is required
E. Unsure
6. Prior to receiving an immune checkpoint inhibitor, genomic analysis reveals a high tumor mutational burden (TMB) in this patient's tumor. This suggests that:
A. The patient is more likely to respond to such treatment
B. The patient is less likely to respond to such treatment
C. TMB is uninformative in the decision-making process
D. There is an increased risk of immune-related adverse events (irAEs) with immunotherapy
E. Unsure
7. Use the following case to answer questions 7 through 9:
A. Maintain treatment since the pneumonitis will likely subside within 2 weeks
B. Hold immunotherapy and treat with corticosteroids until pneumonitis is grade 1 or resolved
C. Discontinue this regimen and start a different therapy lacking an immune checkpoint inhibitor
D. Discontinue chemotherapy and maintain atezolizumab monotherapy until rash has resolved
E. Unsure
8. Six months later, the patient presents with enlarged lymph nodes and liver involvement on CT scan. She is not considered eligible for re-treatment with the first-line chemotherapy regimen, so intravenous topotecan is administered. Despite an initial response, she relapses after 4 months. Her oncologist decides to try a treatment incorporating an immune checkpoint inhibitor. Which of the following would be appropriate?
A. Single-agent pembrolizumab
B. Avelumab
C. Ipilimumab plus prophylactic cranial irradiation
D. Durvalumab plus prophylactic cranial irradiation
E. Unsure
9. After receiving 5 months of third-line therapy with an immune checkpoint inhibitor, the patient complains of acute abdominal pain and bloody diarrhea. Colonoscopy results in a diagnosis of treatment-related acute colitis, which is judged to be severe (grade 4). What is the best course of action?
A. Reduce dose of immunotherapy and provide pain treatment as needed
B. Continue immunotherapy and refer her to a gastroenterologist for further evaluation
C. Hold immunotherapy and treat with intravenous hydration
D. Permanently discontinue immunotherapy and treat with prednisone/methylprednisolone
E. Unsure
10. KW is a 70-year-old male with newly diagnosed extensive-stage small cell lung cancer (ES-SCLC). KW has a past medical history including chronic obstructive pulmonary disease and hypertension. He has an ECOG performance status of 1. What is the best option for first-line systemic treatment?
A. Cisplatin-etoposide
B. Nivolumab-ipilimumab
C. Carboplatin-etoposide-durvalumab
D. Topotecan
E. Unsure
Evaluation Questions
11. How confident are in your treatment choices for the patients in the post-test?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
