| Question 1: Targeting the tumor with local radiotherapy during immunotherapy can: |
| Reference: | Formenti SC, Demaria S. Combining radiotherapy and cancer immunotherapy: a paradigm shift. J Natl Cancer Inst. 2013;105(4):256-265. |
| Choice A: | Enhance in field responses |
| Choice B: | Enhance out of the field responses |
| Choice C: | Enhance both in field and out of field responses |
| Choice D: | Reduce toxicity of immune checkpoint blockade strategies |
| Choice E: | None of the above |
| Question 2: CD8 + T cells are important for: |
| Reference: | Irradiation and Immunotherapy: From Concept to the Clinic, April K. S. Salama, MD; Michael A. Postow, MD; and Joseph K. Salama, MD Cancer, Vol 122, Issue 11, pp 1659-1671, 2016 |
| Choice A: | Direct killing of tumor cells |
| Choice B: | Helping B cells produce antibody |
| Choice C: | Are part of the innate immune system |
| Choice D: | Making antibodies |
| Question 3: Localized Ionizing Radiation has: |
| Reference: | Demaria S, Golden EB, Formenti SC. Role of Local Radiation Therapy in Cancer Immunotherapy. JAMA Oncol. 2015 Aug 13. |
| Choice A: | Pro-immunogenic effects |
| Choice B: | Immunosuppressive effects |
| Choice C: | All of the above |
| Question 4: Which of the following statements regarding toxicities associated with PD-1 inhibitors is correct? |
| Reference: | Johnson DB, Balko JM, Compton ML, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med 2016;375:1749-55.
Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade. N. Engl. J. Med. 2018;378:158–168. doi: 10.1056/NEJMra1703481. |
| Choice A: | The spectrum and frequency of immune related toxicities observed are very similar among patients treated with CTLA-4 inhibitors and patients treated with PD-1 inhibitors. |
| Choice B: | Rare immune related events, such as myocarditis, have been observed following treatment with immune checkpoint blockade and can be life threatening. |
| Choice C: | Delayed treatment of immune mediated toxicities have been associated with superior outcomes because the use of glucocorticoids is minimized. |
| Choice D: | Pneumonitis is the most common serious immune related toxicity observed following treatment with ipilimumab in melanoma patients. |
| Question 5: Which of the following results was reported by the pooled analysis of two randomized trials of Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer (Theelen W et al., Lancet Respir Med 2021): |
| Reference: | [1] Theelen W. et al., JAMA Oncol. 2019 Sep 1;5(9):1276-1282. doi: 10.1001/jamaoncol.2019.1478.
[2] Theelen W. et al., Lancet Respir Med. 2021 May;9(5):467-475. doi: 10.1016/S2213-2600(20)30391-X. |
| Choice A: | No difference in Overall Survival between the randomized cohorts |
| Choice B: | Worse progression free survival in the patients that received pembrolizumab combined with radiation |
| Choice C: | A statistically significant improvement in median overall survival in the patients that received pembrolizumab plus radiotherapy |
| Choice D: | A non-significant trend towards improved overall survival in the patients that received pembrolizumab plus radiotherapy |
| Question 6: Which of the following are true in regards to the results of the PACIFIC trial for patients with stage 3 non small cell lung cancer (NSCLC) (Antonia et al. NEJM 2018)? |
| Reference: | Antonia SJ, Villegas A, Danie D, et al. N Engl J Med. 2018 Dec 13;379(24):2342-2350. doi: 10.1056/NEJMoa1809697. Epub 2018 Sep 25. PMID: 30280658 |
| Choice A: | The study was stopped early because of enhanced toxicity with durvalumab following chemoradiation. |
| Choice B: | There were significant benefits to disease free and overall survival with the use of durvalumab as compared to placebo therapy. |
| Choice C: | There were significant benefits to disease free survival but not overall survival with the use of durvalumab as compared to placebo therapy. |
| Choice D: | Increased treatment related deaths in the durvalumab arm negated the clinical benefit provided. |
