Immunotherapy

Question 1

What drugs are in the Anti-PD-1 class?

Answer 1

Drugs in this class are:
- Nivolumab
- Pembrolizumab
- Cemiplimab
- Dostarlimab
- Retifanlimab
- Nivolumab+Relatlimab

Question 2

What drugs are in the Anti-PD-L1 class?

Answer 2

Drugs in this class are:
- Atezolizumab
- Avelumab
- Durvalumab

Question 3

What drugs are in the Anti-CTLA4?

Answer 3

Drugs in this class are:
- lpilimumab
- Tremelimumab

Question 4

What is the brand name of Nivolumab?

Answer 4

The brand name of this generic drug is:
- Opdivo

Question 5

What is the brand name of Pembrolizumab?

Answer 5

The brand name of this generic drug is:
- Keytruda

Question 6

What is the brand name of Cemiplimab?

Answer 6

The brand name of this generic drug is:
- Libtayo

Question 7

What is the brand name of Dostarlimab?

Answer 7

The brand name of this generic drug is:
- Jemperli

Question 8

What is the brand name of Retifanlimab?

Answer 8

The brand name of this generic drug is:
- Zynyz

Question 9

What is the brand name of Nivolumab+Relatlimab?

Answer 9

The brand name of this generic drug is:
- Opdualag

Question 10

What is the brand name of Atezolizumab?

Answer 10

The brand name of this generic drug is:
- Tecentriq

Question 11

What is the brand name of Avelumab?

Answer 11

The brand name of this generic drug is:
- Bavencio

Question 12

What is the brand name of Durvalumab?

Answer 12

The brand name of this generic drug is:
- Imfinzi

Question 13

What is the brand name of lpilimumab?

Answer 13

The brand name of this generic drug is:
- Yervoy

Question 14

What is the brand name of Tremelimumab?

Answer 14

The brand name of this generic drug is:
- Imjudo

Question 15

What is the generic of name of Opdivo?

Answer 15

The generic name of this brand name drug is:
- Nivolumab

Question 16

What is the generic of name of Keytruda?

Answer 16

The generic name of this brand name drug is:
- Pembrolizumab

Question 17

What is the generic of name of Libtayo?

Answer 17

The generic name of this brand name drug is:
- Cemiplimab

Question 18

What is the generic of name of Jemperli?

Answer 18

The generic name of this brand name drug is:
- Dostarlimab

Question 19

What is the generic of name of Zynyz?

Answer 19

The generic name of this brand name drug is:
- Retifanlimab

Question 20

What is the generic of name of Opdualag?

Answer 20

The generic name of this brand name drug is:
- Nivolumab+Relatlimab

Question 21

What is the generic of name of Tecentriq?

Answer 21

The generic name of this brand name drug is:
- Atezolizumab

Question 22

What is the generic of name of Bavencio?

Answer 22

The generic name of this brand name drug is:
- Avelumab

Question 23

What is the generic of name of Imfinzi?

Answer 23

The generic name of this brand name drug is:
- Durvalumab

Question 24

What is the generic of name of Yervoy?

Answer 24

The generic name of this brand name drug is:
- lpilimumab

Question 25

What is the generic of name of Imjudo?

Answer 25

The generic name of this brand name drug is:
- Tremelimumab

Question 26

What is the class and MOA of Nivolumab?

Answer 26

This drug in the following class:
- Immunotherapy - Anti-PD-1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 27

What is the class and MOA of Pembrolizumab?

Answer 27

This drug in the following class:
- Immunotherapy - Anti-PD-1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 28

What is the class and MOA of Cemiplimab?

Answer 28

This drug in the following class:
- Immunotherapy - Anti-PD-1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 29

What is the class and MOA of Dostarlimab?

Answer 29

This drug in the following class:
- Immunotherapy - Anti-PD-1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 30

What is the class and MOA of Retifanlimab?

Answer 30

This drug in the following class:
- Immunotherapy - Anti-PD-1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 31

What is the class and MOA of Nivolumab+Relatlimab?

Answer 31

This drug in the following class:
- Immunotherapy - Anti-PD-1 + Anti-LAG-3

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 32

What is the class and MOA of Atezolizumab?

Answer 32

This drug in the following class:
- Immunotherapy - Anti-PD-L1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 33

What is the class and MOA of Avelumab?

Answer 33

This drug in the following class:
- Immunotherapy - Anti-PD-L1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 34

What is the class and MOA of Durvalumab?

Answer 34

This drug in the following class:
- Immunotherapy - Anti-PD-L1

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 35

What is the class and MOA of lpilimumab?

Answer 35

This drug in the following class:
- Immunotherapy - Anti-CTLA4

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 36

What is the class and MOA of Tremelimumab?

Answer 36

This drug in the following class:
- Immunotherapy - Anti-CTLA4

This drug’s MOA is as follows:
- Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Question 37

What are the notable/common monitoring parameters for the Immunotherapy class?

Answer 37

The notable/common monitoring parameters for this drug class are:
- TSH/T4 at baseline and every 4-6 weeks
- LFTs (AST, ALT, and bilirubin) at baseline and periodically during treatment
- Serum creatinine at baseline and periodically during treatment

Question 38

Describe the emetic potential of the Anti-PD-1 class.

Answer 38

The emetic potential of this drug class is:
- Minimal

Question 39

Describe the emetic potential of the Anti-PD-L1 class.

Answer 39

The emetic potential of this drug class is:
- Minimal

Question 40

Describe the emetic potential of the Anti-CTLA4 class.

Answer 40

The emetic potential of this drug class is:
- Minimal

Question 41

Describe the extravasation risk and management strategies for the Anti-PD-1 class.

Answer 41

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 42

Describe the extravasation risk and management strategies for the Anti-PD-L1 class.

Answer 42

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 43

Describe the extravasation risk and management strategies for the Anti-CTLA4 class.

Answer 43

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 44

What are the notable/common ADRs of the Immunotherapy class Immune Checkpoint inhibitors: Anti-PD-1, Anti-PD-L1, Anti-CTLA4)?

Answer 44

The notable/common ADRs of this drug class are:
- Immune related adverse events (irAEs)
- These irAEs can affect any organ/tissue in the body (skin, GI tract lungs, liver, thyroid, etc.).
- The most common irAEs with these agents are rash, pruritus, diarrhea, colitis, elevated liver enzymes/ bilirubin, hepatitis, hypophysitis, and hypothyroidism.

Question 45

Describe the strategy and rationale for management of irAEs caused by Immunotherapy (Immune Checkpoint inhibitors: Anti-PD-1, Anti-PD-L1, Anti-CTLA4).

Answer 45

The strategy and rationale for management of this condition caused by this drug are:
- Patients should be educated on the mechanism of action of immunotherapy and when a new side effect occurs, there should be a high suspicion for it being treatment-related.
- Though treatment interruption may be needed for some irAEs depending on severity, dose adjustments are not recommended after restarting therapy following toxicity.
- Toxicity Management (except hypothyroidism):
- Grade 1 toxicity: Continue immunotherapy with close monitoring
- Grade 2 toxicity: Hold immunotherapy (may resume when toxicity< grade 1). Prednisone 0.5-1 mg/kg/day or equivalent may be administered
- Grade 3 toxicity: Hold immunotherapy (may resume when toxicity< grade 1). Start prednisone 1-2 mg/ kg/ day or methylprednisolone IV 1-2 mg/kg/day with taper over > 4-6 weeks. If no improvement after 48-72 hours, then consider infliximab
- Grade 4 toxicity: Permanently discontinue immunotherapy

Question 46

Describe the strategy and rationale for management of hypothyroidism caused by Immunotherapy (Immune Checkpoint inhibitors: Anti-PD-1, Anti-PD-L1, Anti-CTLA4).

Answer 46

The strategy and rationale for management of this condition caused by this drug are:
- Thyroid supplementation in symptomatic patients with TSH levels> 10 mIU/L, monitor every 6-8 weeks while titrating

Question 47

Describe the half-life of Immunotherapy (Immune Checkpoint inhibitors: Anti-PD-1, Anti-PD-L1, Anti-CTLA4).

Answer 47

The half-life of the this drug is described as follows:
- The typical half-life of these agents ranges from 15-27 days
- This leads to a longer time to tumor response compared to traditional cytotoxic chemotherapy

Question 48

What are the clinical pearls of the Immunotherapy class (Immune Checkpoint inhibitors: Anti-PD-1, Anti-PD-L1, Anti-CTLA4)?

Answer 48

The clinical pearls of this drug class are as follows:
- Drug interactions
- As steroids are known to reduce the immune response (and are used to treat immune related adverse events), they may diminish the therapeutic effect of Immune Checkpoint Inhibitors.
- Carefully consider the need for corticosteroids during the initiation of Immune Checkpoint inhibitor therapy.
- Generally, doses of a prednisone-equivalent of 10 mg or less per day are permitted.
- Combining nivolumab (anti-PD-1) with ipilimumab (anti-CTLA-4) results in enhanced T-cell function that is greater than that of either antibody alone, resulting in improved anti-tumor responses in metastatic melanoma and advanced renal cell carcinoma.

Question 49

What are the clinical pearls of Pembrolizumab?

Answer 49

The clinical pearls of this drug are as follows:
- It was one of the first oncology drugs approved for a specific genetic marker (tumors with high microsatellite instability) regardless of cancer type or tissue diagnosis.
- This means that any patient whose tumor is MSI high is eligible to receive this drug.