Immunotherapy

Question 1

MoA Tremelimumab

Answer 1

CTLA-4 inhibitor

Question 2

MoA Ipilimumab

Answer 2

CTLA-4 inhibitor

Question 3

What is the earliest onset ICI related toxicity?

Answer 3

rash

Question 4

management of G1 ICI related maculopapular rash

Answer 4

Continue ICI
Oral antihistamine, topical emollient

Question 5

Treatment of G3 maculopapular rash

Answer 5

Hold ICI
Topical high potency steroids or prednisone

Question 6

At what grade of pruritus do you hold ICI?

Answer 6

G3

Question 7

At what grade of ICI related colitis do you hold treatment?

Answer 7

Grade 2 (4-6 BMs > baseline)

Question 8

7+ BMs more than baseline is what grade colitis?

Answer 8

G3

Question 9

4-6 BMs more than baseline is what grade colitis?

Answer 9

G2

Question 10

When do you permanently discontinue ICI because of colitis?

Answer 10

G4

Question 11

At what grade of elevated LFTs do you hold immunotherapy?

Answer 11

G2

Question 12

Grade this elevated LFT: 3-5x ULN

Answer 12

G2

Question 13

Grade this elevated LFT: 5-20x ULN

Answer 13

G3

Question 14

Grade this elevated LFT: >20x ULN

Answer 14

G4

Question 15

Treatment for G3-4 ICI-colitis that doesn’t respond to methylpred after 2 days?

Answer 15

Vedolizumab or infliximab

Question 16

How do you classify a G1 rash?

Answer 16

<10% BSA

Question 17

How do you classify G2 rash?

Answer 17

10-30% BSA

Question 18

How do you classify G3 rash?

Answer 18

> 30% BSA

Question 19

How do you classify G4 rash?

Answer 19

Any % BSA
Associated with extensive superinfection, IV antibiotics likely indicated

Question 20

Oral morphine to IV morphine

Answer 20

3:1

Question 21

Oral morphine to PO Hydromorphone

Answer 21

4:1

Question 22

Oral morphine to PO oxycodone

Answer 22

1.5-2 mg PO morphine : 1 mg oxy

Question 23

Oral morphine to PO tramadol

Answer 23

1:10

Question 24

Oral Morphine to SC Morphine

Answer 24

3:1

Question 25

Management of asymptomatic ICI pneumonitis

Answer 25

Observation