Advancing Pharmacist Excellence in Solid Tumors: Essential Considerations for Expanding From IV to Subcutaneous Immune Checkpoint Inhibitors : Pre-test

1.

How many people with cancer do you provide care for in a typical month?

A. 1-4
B. 5-10
C. 11-15
D. 16-20
E. >20
F. Not applicable

2.

Which best describes your practice setting?

A. Academic
B. Community
C. Not applicable

3.

Patient Case 1: 70-Yr-Old With Metastatic RCC

Patient NS is a 70-yr-old male with metastatic RCC whose oncologist is recommending axitinib plus pembrolizumab SC

NS and his wife have questions about using pembrolizumab SC and wonder whether efficacy and side effects are different between IV and SC

His wife is a retired nurse, and she is asking whether she can administer pembrolizumab SC at home

Vitals
- BP: 120/75 mm Hg; height: 5’11”; weight: 170 lb

PMH: hypertension, seasonal allergies, osteoarthritis

Medications: lisinopril 20 mg QD, cetirizine 10 mg QD, acetaminophen PRN

How would you counsel this patients and his wife about subcutaneous immunotherapy compared with intravenous formulation?

A. Can be administered by a patient/caregiver in the home
B. Can be administered in the thigh or abdomen
C. There are fewer side effects with pembrolizumab SC compared to IV
D. Efficacy is improved with pembrolizumab SC compared to IV

4.

Which of the following could be a potential challenge for successfully implementing use of subcutaneous immunotherapies (ie, atezolizumab, pembrolizumab, or nivolumab)?

A. Institutions will lose money, as port utilization will decrease
B. Insurance provider may prefer home administration with a visiting nurse
C. Patients may become dissatisfied with SC administration in thigh or abdomen
D. SC immunotherapies are likely to be more expensive than IV

5.

Patient Case 2: 60-Yr-Old Female Diagnosed With Metastatic Cutaneous Melanoma

Patient CM is a 60-yr-old female diagnosed with metastatic cutaneous melanoma

Her oncologist would like to start her on dual immunotherapy with ipilimumab plus nivolumab Q3W x 4 cycles followed by nivolumab Q4W for up to 2 yr

Which of the following is true when considering subcutaneous immunotherapy for this patient who is about to receive combination nivolumab with ipilimumab therapy?

A. After the first 4 cycles of combination nivolumab with ipilimumab IV therapy, nivolumab can be given SC in the maintenance phase
B. Ipilimumab and nivolumab can both be given subcutaneously
C. Ipilimumab cannot be given SC, but nivolumab can be given SC both in combination and as monotherapy
D. Nivolumab cannot be given SC when used in combination with ipilimumab nor in monotherapy in this regimen

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Advancing Pharmacist Excellence in Solid Tumors: Essential Considerations for Expanding From IV to Subcutaneous Immune Checkpoint Inhibitors

Shawna Kraft, PharmD, BCOP

Kelly Romo, PharmD, BCOP

Pretest

Please answer the questions below.

1.

2.

3.

4.

5.