1. Antibody-drug conjugates (ADCs) are complex drug delivery systems composed of a monoclonal antibody (mAb), linker (cleavable or non-cleavable), and payload. If an ADC has a non-cleavable linker, how is the payload released at the site of action?
A. The payload does not release from an ADC with a non-cleavable linker
B. The payload is released when the mAb is enzymatically degraded in the lysosome
C. The payload is released when the ADC is exposed to the low pH of a cancer cell
D. The payload is released upon glutathione-mediated reduction of the linker
E. Unsure
2. The differential targeting of ADCs to cancer cells allows for the use of more potent payloads, which carry the risk of increased clinical toxicity. Which of the following describes the phenomenon that leads to increased clinical toxicity?
A. Complement-mediated cytotoxicity
B. Magic bullet
C. Selective targeting
D. Off-target release
E. Unsure
3. Many of the ADCs carry black box warnings (BBWs) to highlight serious adverse effects that may occur. The FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for serious ocular toxicities associated with which of the following ADC products?
A. Inotuzumab ozogamicin
B. Loncastuximab tesirine
C. Belantamab mafodotin
D. Tisotumab vedotin
E. Unsure
4. Similar to other mAb-based products, ADCs are prone to infusion-related reactions, which may be mitigated through regimens of premedication. Which of the following best describes the most common drugs used to premedicate prior to infusion of ADCs?
A. Acetaminophen, antihistamine, corticosteroid
B. Nonsteroidal anti-inflammatory drug (NSAID), antihistamine, corticosteroid
C. Acetaminophen, antiemetic, corticosteroid
D. Acetaminophen, antipyretic, corticosteroid
E. Unsure
5. Recommended treatments for the severe diarrhea associated with sacituzumab govitecan are based on whether the diarrhea is early onset or late onset. Which of the following best describes the recommended pharmacotherapy for this adverse effect?
A. Loperamide for early onset; atropine for late onset
B. Ondansetron for early onset; loperamide for late onset
C. Atropine for early onset; ondansetron for late onset
D. Atropine for early onset; loperamide for late onset
E. Unsure
6. With the differential targeting to the site of action and the increased potency of payloads, the overall dose of chemotherapeutic drugs from ADCs is lower than conventional therapies. While this limits the potential for drug-drug interactions (DDIs), some ADCs have cautions about DDIs. Which of the following ADCs has the potential for DDIs with inhibitors or inducers of UGT1A1?
A. Sacituzumab govitecan
B. Inotuzumab ozogamicin
C. ADCs with vedotin as the payload
D. Ado-trastuzumab emtansine
E. Unsure
7. As new and complex drug products, ADCs have high price tags that can top $450,000 in treatment costs. Which of the following terms describes the phenomenon of financial issues negatively impacting patient outcomes?
A. Medical bankruptcy
B. Financial toxicity
C. Financial burden
D. Medical toxicity
E. Unsure
8. Pharmacists can play key roles in patient-centered oncology care with ADCs including which of the following?
A. Prescribing appropriate ADC chemotherapy under a collaborative practice agreement
B. Administer premedications, ADCs, and rescue medications
C. Switching from a reference ADC product to a biosimilar
D. Providing patient education on potential adverse effects and DDIs
E. Unsure
9. ADCs are prepared by reconstitution of lyophilized powders and administered as IV infusions. Which of the following is NOT a common direction for the preparation of ADCs?
A. Keep product from freezing
B. Protect solution from light
C. After adding diluent, shake vial well to dissolve contents
D. After adding diluent, swirl vial gently to dissolve contents
E. Unsure
10. WW is a 61-year-old patient with metastatic cervical cancer. She has progressed early following platinum-doublet chemotherapy plus bevacizumab and the oncology team is considering tisotumab vedotin as the next option. As the oncology pharmacist on the team, what important counseling points should you discuss with WW?
A. Regular eye exams will be needed before, during, and after treatment to screen for ocular toxicity
B. Liver function tests will be needed before, during, and after treatment to screen for hepatotoxicity
C. The patient will have to follow the REMS program for the drug
D. The drug may cause severe diarrhea, which may be treated with atropine or loperamide
E. Unsure
Evaluation Questions
11. How confident are you in your treatment choice for WW in the previous question?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
