Board Certified Oncology Pharmacist (BCOP) Exam 2026:
Professional Certification Practice Test — Cancer Pharmacotherapy,
Chemotherapy, Immunotherapy, Toxicity Management & Supportive
Care — 190 Multiple-Choice Questions with Answers & Detailed
Rationales
DOMAIN 1: ONCOLOGY DIAGNOSIS AND TESTING
Cancer Biology and Molecular Testing
Question 1
A 58-year-old woman is diagnosed with invasive ductal carcinoma of the breast. Biopsy
results show ER-positive, PR-negative, and HER2 equivocal by immunohistochemistry. What
is the most appropriate next step in biomarker evaluation?
A. Repeat core needle biopsy for confirmation
B. Perform fluorescence in situ hybridization (FISH) for HER2
C. Initiate endocrine therapy with tamoxifen
D. Order germline BRCA1/2 mutation testing
Correct Answer: B
Explanation: HER2 equivocal by IHC requires reflex FISH testing to definitively determine
HER2 status, which guides anti-HER2 therapy eligibility and prognosis.
Question 2
Which molecular abnormality is characteristic of chronic myeloid leukemia (CML)?
A. JAK2 V617F mutation
B. PML-RARA fusion gene
,C. BCR-ABL1 fusion gene
D. FLT3 internal tandem duplication
Correct Answer: C
Explanation: The Philadelphia chromosome results from t(9;22) translocation creating BCR-
ABL1 fusion, a constitutively active tyrosine kinase driving CML pathogenesis .
Question 3
A 62-year-old man with metastatic non-small cell lung cancer undergoes molecular profiling.
Which biomarker is most critical to assess before initiating first-line therapy in a never-
smoker with adenocarcinoma histology?
A. PD-L1 expression level
B. KRAS G12C mutation
C. EGFR mutation status
D. ALK rearrangement
Correct Answer: C
Explanation: EGFR mutations occur in approximately 10-15% of Western NSCLC patients and
up to 40% in Asian populations; EGFR-TKIs are first-line therapy for EGFR-mutant disease .
Question 4
Which tumor marker is most useful for monitoring treatment response in epithelial ovarian
cancer?
A. CEA
B. CA 19-9
,C. CA 125
D. AFP
Correct Answer: C
Explanation: CA 125 is elevated in approximately 80% of advanced ovarian cancers and is
used to monitor treatment response and detect recurrence .
Question 5
A patient with colorectal cancer is being considered for anti-EGFR therapy. Which molecular
test result would contraindicate cetuximab use?
A. KRAS wild-type
B. NRAS mutation
C. BRAF V600E mutation
D. MSI-high status
Correct Answer: B
Explanation: RAS mutations (KRAS or NRAS) confer primary resistance to anti-EGFR
monoclonal antibodies; only RAS wild-type tumors benefit from cetuximab or panitumumab
.
Question 6
Which hereditary cancer syndrome is associated with mutations in MLH1, MSH2, or MSH6
genes?
A. Li-Fraumeni syndrome
B. Lynch syndrome
, C. Familial adenomatous polyposis
D. Hereditary breast and ovarian cancer syndrome
Correct Answer: B
Explanation: Lynch syndrome results from mismatch repair gene mutations, increasing risk of
colorectal, endometrial, and other cancers .
Question 7
What is the primary function of tumor suppressor genes in normal cellular physiology?
A. Promote cell cycle progression
B. Inhibit apoptosis
C. Regulate cell division and prevent uncontrolled growth
D. Induce angiogenesis
Correct Answer: C
Explanation: Tumor suppressor genes such as TP53 and RB1 regulate cell division and
prevent uncontrolled proliferation; their loss contributes to carcinogenesis .
Question 8
A 45-year-old woman with triple-negative breast cancer undergoes genetic testing and is
found to have a BRCA1 pathogenic variant. Which class of agents targets this vulnerability?
A. CDK4/6 inhibitors
B. PARP inhibitors
C. Aromatase inhibitors
D. HER2-directed antibodies
Professional Certification Practice Test — Cancer Pharmacotherapy,
Chemotherapy, Immunotherapy, Toxicity Management & Supportive
Care — 190 Multiple-Choice Questions with Answers & Detailed
Rationales
DOMAIN 1: ONCOLOGY DIAGNOSIS AND TESTING
Cancer Biology and Molecular Testing
Question 1
A 58-year-old woman is diagnosed with invasive ductal carcinoma of the breast. Biopsy
results show ER-positive, PR-negative, and HER2 equivocal by immunohistochemistry. What
is the most appropriate next step in biomarker evaluation?
A. Repeat core needle biopsy for confirmation
B. Perform fluorescence in situ hybridization (FISH) for HER2
C. Initiate endocrine therapy with tamoxifen
D. Order germline BRCA1/2 mutation testing
Correct Answer: B
Explanation: HER2 equivocal by IHC requires reflex FISH testing to definitively determine
HER2 status, which guides anti-HER2 therapy eligibility and prognosis.
Question 2
Which molecular abnormality is characteristic of chronic myeloid leukemia (CML)?
A. JAK2 V617F mutation
B. PML-RARA fusion gene
,C. BCR-ABL1 fusion gene
D. FLT3 internal tandem duplication
Correct Answer: C
Explanation: The Philadelphia chromosome results from t(9;22) translocation creating BCR-
ABL1 fusion, a constitutively active tyrosine kinase driving CML pathogenesis .
Question 3
A 62-year-old man with metastatic non-small cell lung cancer undergoes molecular profiling.
Which biomarker is most critical to assess before initiating first-line therapy in a never-
smoker with adenocarcinoma histology?
A. PD-L1 expression level
B. KRAS G12C mutation
C. EGFR mutation status
D. ALK rearrangement
Correct Answer: C
Explanation: EGFR mutations occur in approximately 10-15% of Western NSCLC patients and
up to 40% in Asian populations; EGFR-TKIs are first-line therapy for EGFR-mutant disease .
Question 4
Which tumor marker is most useful for monitoring treatment response in epithelial ovarian
cancer?
A. CEA
B. CA 19-9
,C. CA 125
D. AFP
Correct Answer: C
Explanation: CA 125 is elevated in approximately 80% of advanced ovarian cancers and is
used to monitor treatment response and detect recurrence .
Question 5
A patient with colorectal cancer is being considered for anti-EGFR therapy. Which molecular
test result would contraindicate cetuximab use?
A. KRAS wild-type
B. NRAS mutation
C. BRAF V600E mutation
D. MSI-high status
Correct Answer: B
Explanation: RAS mutations (KRAS or NRAS) confer primary resistance to anti-EGFR
monoclonal antibodies; only RAS wild-type tumors benefit from cetuximab or panitumumab
.
Question 6
Which hereditary cancer syndrome is associated with mutations in MLH1, MSH2, or MSH6
genes?
A. Li-Fraumeni syndrome
B. Lynch syndrome
, C. Familial adenomatous polyposis
D. Hereditary breast and ovarian cancer syndrome
Correct Answer: B
Explanation: Lynch syndrome results from mismatch repair gene mutations, increasing risk of
colorectal, endometrial, and other cancers .
Question 7
What is the primary function of tumor suppressor genes in normal cellular physiology?
A. Promote cell cycle progression
B. Inhibit apoptosis
C. Regulate cell division and prevent uncontrolled growth
D. Induce angiogenesis
Correct Answer: C
Explanation: Tumor suppressor genes such as TP53 and RB1 regulate cell division and
prevent uncontrolled proliferation; their loss contributes to carcinogenesis .
Question 8
A 45-year-old woman with triple-negative breast cancer undergoes genetic testing and is
found to have a BRCA1 pathogenic variant. Which class of agents targets this vulnerability?
A. CDK4/6 inhibitors
B. PARP inhibitors
C. Aromatase inhibitors
D. HER2-directed antibodies
