BCOP Oncology Pharmacy Certification Exam 2026: Advanced
Professional Practice Test — Cancer Pharmacotherapy,
Chemotherapy Safety, Immunotherapy, Targeted Therapy,
Supportive Care & Oncologic Emergencies — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
DOMAIN 1: PATIENT ASSESSMENT AND CARE PLANNING (Questions 1–44)
Question 1
A 58-year-old woman with newly diagnosed invasive ductal carcinoma undergoes tumor
profiling. The report identifies a germline pathogenic variant in BRCA1. Which cellular
process is most directly impaired by this mutation?
A. Mismatch repair
B. Nucleotide excision repair
C. Homologous recombination repair
D. Base excision repair
Correct Answer: C
Explanation: BRCA1 is critical for homologous recombination repair of double-strand DNA
breaks. Loss leads to genomic instability and sensitivity to PARP inhibitors.
Question 2
A 62-year-old man presents with fatigue, splenomegaly, and a WBC count of 85,000/mm³.
FISH analysis detects t(9;22). Which molecular abnormality is present?
A. PML-RARA fusion
B. BCR-ABL1 fusion
,C. JAK2 V617F mutation
D. FLT3-ITD mutation
Correct Answer: B
Explanation: t(9;22) creates the Philadelphia chromosome and BCR-ABL1 fusion, the
hallmark of chronic myeloid leukemia.
Question 3
A tumor is found to have high microsatellite instability (MSI-H) with deficient mismatch
repair. Which immunotherapy is most likely to be effective?
A. Trastuzumab
B. Bevacizumab
C. Pembrolizumab
D. Rituximab
Correct Answer: C
Explanation: MSI-H/dMMR tumors respond to PD-1 inhibitors like pembrolizumab due to
high tumor mutational burden and neoantigen load.
Question 4
A 45-year-old woman with early-stage ER-positive, HER2-negative breast cancer undergoes
Oncotype DX testing. The recurrence score is 12. What is the most appropriate
recommendation?
A. Adjuvant chemotherapy followed by endocrine therapy
B. Endocrine therapy alone
,C. Trastuzumab-based therapy
D. Observation without systemic therapy
Correct Answer: B
Explanation: Low recurrence scores (0–25 for patients ≥50) indicate endocrine therapy alone
is appropriate; chemotherapy adds minimal benefit.
Question 5
A patient with metastatic NSCLC has a PD-L1 tumor proportion score (TPS) of 80%. Which
first-line therapy is most appropriate?
A. Carboplatin plus pemetrexed
B. Pembrolizumab monotherapy
C. Bevacizumab plus paclitaxel
D. Erlotinib
Correct Answer: B
Explanation: High PD-L1 expression (TPS ≥50%) supports first-line pembrolizumab
monotherapy in metastatic NSCLC without actionable driver mutations.
Question 6
A 70-year-old man with prostate cancer has a PSA of 15 ng/mL and Gleason 4+3=7. Which
imaging modality is most appropriate for initial staging?
A. Bone scan alone
B. PSMA PET/CT
C. MRI abdomen
, D. Chest X-ray
Correct Answer: B
Explanation: PSMA PET/CT offers superior sensitivity for detecting nodal and distant
metastases compared to conventional imaging in high-risk prostate cancer.
Question 7
A patient's tumor demonstrates HER2 amplification by FISH. Which agent directly targets this
alteration?
A. Cetuximab
B. Trastuzumab
C. Rituximab
D. Bevacizumab
Correct Answer: B
Explanation: Trastuzumab binds the HER2 receptor, inhibiting downstream proliferation
signals in HER2-amplified cancers.
Question 8
A 55-year-old woman with ovarian cancer has a germline BRCA2 mutation. Which
maintenance therapy is indicated after platinum response?
A. Bevacizumab alone
B. Olaparib
C. Pembrolizumab
D. Tamoxifen
Professional Practice Test — Cancer Pharmacotherapy,
Chemotherapy Safety, Immunotherapy, Targeted Therapy,
Supportive Care & Oncologic Emergencies — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
DOMAIN 1: PATIENT ASSESSMENT AND CARE PLANNING (Questions 1–44)
Question 1
A 58-year-old woman with newly diagnosed invasive ductal carcinoma undergoes tumor
profiling. The report identifies a germline pathogenic variant in BRCA1. Which cellular
process is most directly impaired by this mutation?
A. Mismatch repair
B. Nucleotide excision repair
C. Homologous recombination repair
D. Base excision repair
Correct Answer: C
Explanation: BRCA1 is critical for homologous recombination repair of double-strand DNA
breaks. Loss leads to genomic instability and sensitivity to PARP inhibitors.
Question 2
A 62-year-old man presents with fatigue, splenomegaly, and a WBC count of 85,000/mm³.
FISH analysis detects t(9;22). Which molecular abnormality is present?
A. PML-RARA fusion
B. BCR-ABL1 fusion
,C. JAK2 V617F mutation
D. FLT3-ITD mutation
Correct Answer: B
Explanation: t(9;22) creates the Philadelphia chromosome and BCR-ABL1 fusion, the
hallmark of chronic myeloid leukemia.
Question 3
A tumor is found to have high microsatellite instability (MSI-H) with deficient mismatch
repair. Which immunotherapy is most likely to be effective?
A. Trastuzumab
B. Bevacizumab
C. Pembrolizumab
D. Rituximab
Correct Answer: C
Explanation: MSI-H/dMMR tumors respond to PD-1 inhibitors like pembrolizumab due to
high tumor mutational burden and neoantigen load.
Question 4
A 45-year-old woman with early-stage ER-positive, HER2-negative breast cancer undergoes
Oncotype DX testing. The recurrence score is 12. What is the most appropriate
recommendation?
A. Adjuvant chemotherapy followed by endocrine therapy
B. Endocrine therapy alone
,C. Trastuzumab-based therapy
D. Observation without systemic therapy
Correct Answer: B
Explanation: Low recurrence scores (0–25 for patients ≥50) indicate endocrine therapy alone
is appropriate; chemotherapy adds minimal benefit.
Question 5
A patient with metastatic NSCLC has a PD-L1 tumor proportion score (TPS) of 80%. Which
first-line therapy is most appropriate?
A. Carboplatin plus pemetrexed
B. Pembrolizumab monotherapy
C. Bevacizumab plus paclitaxel
D. Erlotinib
Correct Answer: B
Explanation: High PD-L1 expression (TPS ≥50%) supports first-line pembrolizumab
monotherapy in metastatic NSCLC without actionable driver mutations.
Question 6
A 70-year-old man with prostate cancer has a PSA of 15 ng/mL and Gleason 4+3=7. Which
imaging modality is most appropriate for initial staging?
A. Bone scan alone
B. PSMA PET/CT
C. MRI abdomen
, D. Chest X-ray
Correct Answer: B
Explanation: PSMA PET/CT offers superior sensitivity for detecting nodal and distant
metastases compared to conventional imaging in high-risk prostate cancer.
Question 7
A patient's tumor demonstrates HER2 amplification by FISH. Which agent directly targets this
alteration?
A. Cetuximab
B. Trastuzumab
C. Rituximab
D. Bevacizumab
Correct Answer: B
Explanation: Trastuzumab binds the HER2 receptor, inhibiting downstream proliferation
signals in HER2-amplified cancers.
Question 8
A 55-year-old woman with ovarian cancer has a germline BRCA2 mutation. Which
maintenance therapy is indicated after platinum response?
A. Bevacizumab alone
B. Olaparib
C. Pembrolizumab
D. Tamoxifen
