1. Which of the following has demonstrated the longest 5-year overall survival in clinical trials for metastatic melanoma, but carries the highest risk of immune-related adverse events (irAEs)?

2. AM is an 83-year-old woman with BRAF V600E-mutated metastatic melanoma with primarily subcutaneous disease on her back, chest, and left axilla. She has a past medical history significant for morbid obesity, congestive heart failure, inflammatory bowel disease (Crohn's disease), and type 1 diabetes (T1D). The oncologist would like to start first-line ICI monotherapy with pembrolizumab.Which of the following comorbidities is associated with an increased risk of complications from ICI treatment?

3.

SP is a 31-year-old woman withBRAF wild-type metastatic melanoma of the lungs and colon. She received relatlimab + nivolumab 4 weeks ago. Today, she calls in to the medical oncology clinic complaining of severe fatigue, widespread muscle aches, and worsening weakness when walking. She is sent to a local emergency department in her rural hometown for evaluation.

Which of the following rare irAEs can present with nonspecific symptoms within weeks of starting ICI therapy and has a high mortality risk if not treated promptly?

4.

DR is a 64-year-old man withBRAF V600K-mutated metastatic melanoma of the right lung. He experienced grade 3 nephritis following cycle 9 of nivolumab. He was started on high-dose prednisone and began a taper once it improved to grade 1. On the fourth week of the high-dose prednisone taper (prednisone 20 mg/d), DR's serum creatinine starts to rise again. The prednisone is increased back to the previous step of the taper (prednisone 40 mg) with more frequent monitoring. The medical oncology team is considering the need for a longer taper, or possibly even adding a secondary immunosuppressant as a steroid-sparing measure. DR has no known drug allergies. Apart from the rising serum creatinine, his most recent complete metabolic panel (CMP) was normal. His past medical history apart from melanoma is only notable for hypertension. He denies any issues with sleep during the steroid taper thus far.

Which of the following prophylactic measures is most important to start at this time?

5.

MB is a 41-year-old man with BRAF wild-type resected stage IIIB melanoma. He presents for clinical evaluation prior to cycle 5 of nivolumab. Last cycle, his thyroid-stimulating hormone (TSH) was undetectable and free thyroxine (T4) was slightly elevated. At that time, he was asymptomatic. Since then, he has become increasingly fatigued and has had a 2-kg weight gain. Today, his TSH is 52 mIU/mL (high) and free T4 is low. He is diagnosed with immune-related thyroiditis, and it is requested that he start replacement treatment for this endocrine irAE.

Which of the following steroid or hormone replacement agents is most appropriate?

Evaluation Questions

6. How confident are you in your treatment choice for MB in the question above?

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