BCOP Exam A+ Pass

BCOP Exam A+ Pass melanoma - Stage I or II - Answer- surgery melanoma - Stage III - Answer- nivolumab, ipilumumab melanoma - BRAF positive Stage III - Answer- dabrafenib + trametinib melanoma - BRAF positive Stage IV, aggressive, bulky, symptomatic - Answer- dabrafenib + trametinib, vemurafenib + cobimetinib melanoma - Unresectable stage III with in-transit lesions - Answer- Talimogene Laherparepvec (T-VEC) melanoma - Stage IV - Answer- nivolumab, pembrolizumab melanoma - BRAF positive Stage IV minimally symptomatic - Answer- nivolumab, pembrolizumab, nivolumab + ipilimumab (Stage IV immunotherapy) metastatic basal cell carcinoma - Answer- vismodegib, sonidegib CLL - Age 65 without significant comorbidies without del 17p/TP53 - Answer- FCR, ibrutinib, bendamustine with or without cd20 MoAb CLL - Age 65 without significant comorbidities without del 17p/TP53 relapse/refractory - Answer- ibrutinib, idelalisib + R, venetoclax with or without R CLL - Age 65 without significant comorbidies without del 17p/TP53 maintenance - Answer- consider lenalidomide for high risk CLL - Age 65 or younger patients with significant comorbidities without del 17p/TP53 - Answer- Obinutuzumab + chlorambucil, ibrutinib, ofatumumab + chlorambucil, rituxan + chlorambucil, bendamustine with or without R CLL - Age 65 or younger patients with significant comorbidities without del 17p/TP53 maintenance - Answer- consider lenalidomide for high risk CLL - Age 65 or younger patients with significant comorbidities without del 17p/TP53 relapse/refractory - Answer- ibrutinib, idelalisib + R, venetoclax with or without R CLL - Frail patients with significant comorbidities without del 17p/TP53 - Answer- Obinutuzumab + chlorambucil, ibrutinib, ofatumumab + chlorambucil, rituxan + chlorambucil CLL - Frail patients with significant comorbidities without del 17p/TP53 maintenance - Answer- consider lenalidomide for high risk Frail patients with significant comorbidities without del 17p/TP53 relapsed/refractory - Answer- ibrutinib, idelalisib + R, venetoclax with or without R CLL - With del 17p/TP53 - Answer- ibrutinib**, HDMP + rituxan, obinutuzumab, alemtuzumab with or without rituxan CLL - With del 17p/TP53 relapsed/refractory - Answer- ibrutinib, idelalisib + R, venetoclax with or without R CLL - With del 17p/TP53 maintenance - Answer- consider lenalidomide for high risk NSCLC stage IA - Answer- surgery NSCLC stage IB - Answer- surgery NSCLC stage IIA - Answer- surgery followed by cisplatin doublet NSCLC stage IIB - Answer- surgery followed by cisplatin doublet NSCLC stage IIIA - Answer- surgery followed by cisplatin doublet NSCLC stage IIIB - Answer- surgery followed by cisplatin doublet + XRT NSCLC stage III consolidation - Answer- durvalumab NSCLC stage IV PD-LI 50% - Answer- pembrolizumab NSCLC stage IV SCC - Answer- cisplatin/gemcitabine NSCLC stage IV adenocarcinoma no driver mutation, no PD-L1 expression - Answer- platinum based doublet or carbo/pem/pem NSCLC stage IV nonsquamous EGFR positive - Answer- erlotinib, afatinib, gefitinib, osimertinib (2a rec) NSCLC stage IV nonsquamous T790M mutation - Answer- osimertinib NSCLC stage IV nonsquamous EML4-ALK positive - Answer- alectinib (preferred), crizotinib, ceritinib NSCLC stage IV nonsquamous ROS-1 positive - Answer- crizotinib, ceritinib NSCLC stage IV nonsquamous BRAF V600E positive - Answer- dabrafenib+trametinib NSCLC continuation maintenance - Answer- pemetrexed (nonsquamous), pemetrexed/avastin, gemzar NSCLC switch maintenance - Answer- pemetrexed (nonsquamous), docetaxel NSCLC stage IV nonsquamous EGFR positive second line - Answer- erlotinib, gefitinib, afatanib NSCLC stage IV nonsquamous EGFR positive third line - Answer- chemo preferred over immunotherapy NSCLC stage IV nonsquamous ALK positive second line - Answer- ceritinib, alectinib, brigatinib NSCLC stage IV nonsquamous ALK positive third line - Answer- chemo preferred over immunotherapy NSCLC stage IV second line after progression on platinum based chemo (immunotherapy) - Answer- nivolumab, pembrolizumab (PD-L1 1%), atezolizumab NSCLC stage IV second line after progression on platinum based chemo (chemo) - Answer- docetaxel, pemetrexed, ramucirumab+docetaxel Stage IV mesothelioma - Answer- Pemetrexed/cisplatin (category 1), pemetrexed/cisplatin/avastin (category 2) Stage 1A or stage 1B (grade 1 and 2) ovarian - Answer- surgical staging + observation. taxane/carbo for 3-6 cycles if grade 2 Stage 1A or 1B (grade 3) and Stage 1C (grade 1, 2, 3) ovarian - Answer- surgical staging + taxane/carbo 3-6 cycles Stage 2 ovarian - Answer- surgical staging + taxane plus platinum IV or IP (in 1cm optimally debulked, category 2a) for 6 cycles Stage 3 ovarian - Answer- surgical staging + taxane/carbo, carbo/doxil, cisplatin/taxol, IP chemo (category 1) Stage 4 ovarian - Answer- surgical staging + taxane/carbo, carbo/doxil, cisplatin/taxol Platinum sensitive recurrent disease ovarian - Answer- disease free for 6 months - platinum based chemo (carbo/taxol, doxil/carbo category 1) Platinum sensitive recurrent disease ovarian w/ neuropathy - Answer- gemzar/carbo or gemzar/cisplatin reverses platinum resistance Platinum sensitive recurrent disease ovarian but cannot tolerate combination chemo - Answer- cisplatin, carboplatin Ovarian Maintenance after response after 2 or more lines of platinum based chemo for recurrent disease - Answer- niraparib, olaparib Platinum resistant ovarian - Answer- taxol/pazopanib (2a), olaparib (BRCA mutations), rucaparib (deleterious BRCA mutation) Cervical Stage IA1 (microscopic early stage) - Answer- fertility sparing conization (3mm negative margins) with or without pelvic lymph node dissection, OR hysterectomy Cervical Stage IA1 (with positive margins or presence of lympho-vascular space invasion), Stage IA2, or stage IB1 - Answer- fertility sparing radical trachelectomy (tumors 2cm) w/ PLND or abdominal trachelectomy (tumors 2-4cm), OR hysterectomy Cervical Stage(with LVSI) - IIA non surgical candidates - Answer- pelvic EBRT with brachytherapy Cervical Stage IB1-IIA1 - Answer- radical hysterectomy with bilateral PLND Cervical Stage IB2-IIA2 - Answer- EBRT with concurrent cisplatin and brachytherapy Cervical Bulky Stage IIB, III, IVA - Answer- pelvic EBRT with concurrent cisplatin and brachytherapy Cervical Stage IVB, recurrent - Answer- cisplatin/taxol/avastin, topotecan/taxol/avastin, cisplatin/taxol, carbo/taxol (if prior cisplatin) Endometrial Stage I and II - Answer- surgery followed by obs, vaginal brachytherapy, and/or EBRT Endometrial Stage III-IVA - Answer- Systemic therapy (carbo/taxol or AP) +- EBRT +- vaginal brachytherapy Follicular, Stage I & II non bulky (grade 1-2) treatment - Answer- ISRT Follicular, Stage I & II bulky disease and stages III & IV (grade 1-2) treatment - Answer- Bendamustine, CHOP, CVP all with either rituxan or obinutuzumab (gazyva) Follicular, Stage I-IV (grade 3A or 3B) treatment - Answer- Treat per DLBCL guidelines