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Sample BCOP Question 1

HT is a 54 year old male with metastatic colorectal cancer who is receiving cetuximab. Which of the following side effects should he be counseled on?

QTc prolongation

Hypomagnesemia

Arterial thromboembolism

Bleeding

Answer: B

Rationale:

Hypomagnesemia is a relatively common side effect associated with epidermal growth factor receptor (EGFR) inhibitors such as cetuximab and panitumumab. Although the mechanism responsible for this electrolyte imbalance is not well understood, increased EGFR expression in the ascending loop of Henle may lead to renal tubular damage and interfere with magnesium reabsorption.
Electrolytes should be monitored routinely and for 8 weeks after the completion of anti-EGFR therapy as magnesium levels typically return to normal ~4-8 weeks after discontinuation of these agents.
QTc prolongation, arterial thromboembolism, and bleeding are not commonly associated with cetuximab.

High-Yield Core Concept:

Although not as common as other side effects, hypomagnesemia has been associated with cetuximab and panitumumab. Patient's electrolytes should be frequently monitored during the duration of EGFR inhibitor treatment and for approximately 8 weeks afterwards.

High-Yield Fast Fact(s):

Hypomagnesemia secondary to anti-EGFR therapy can lead to cardiovascular, neuromuscular and behavioral symptoms and can also be associated with hypocalcemia.
This type of hypocalcemia is due to hypomagnesemia-induced parathyroid hormone (PTH) resistance and can only be corrected by replacing magnesium.

Reference:

Curr Oncol. 2010 Jul;17 Suppl 1:S18-30.
Exp Ther Med. 2010 Mar;1(2):307-311.

Sample BCOP Question 2

AL is a Caucasian 42 year old female who has a history of a gastric ulcer secondary to Helicobacter pylori infection. When questioned about her dietary habits, AL replies that she eats a burger and fries daily at the cafeteria and drinks 1-2 beers/week socially. In addition, her father was diagnosed with gastric cancer at age 51. Which of the following risk factors dose AL have for gastric cancer?

Ethnicity, H. pylori infection, diet

H. pylori infection, alcohol use, family history

Ethnicity, H. pylori infection, alcohol use

H. pylori infection, diet, family history

Answer: D

Rationale:

H. pylori infection, a diet high in salted, fried or preserved foods and low in fruits and vegetables, and a positive family history are all risk factors for gastric cancer.
Gastric cancer is one of the least common cancers diagnosed in North America whereas it is rampant in other parts of the world such as Asia. It is more commonly diagnosed in Asian/Pacific Islanders, Hispanics and African Americans. Therefore, AL would not be at high risk due to her ethnicity.
While a meta-analysis showed a lack of association between moderate alcohol consumption and gastric cancer risk, there was a positive association with heavy alcohol drinking (≥ 4 drinks/day) especially for non-cardiac gastric cancers. AL would not be considered a heavy drinker.

High-Yield Core Concept:

Risk factors for gastric cancer include H. pylori infection, smoking, a diet high in salted, fried or preserved foods and low in fruits and vegetables, positive family history, and heavy alcohol use.
Gastric cancer is also one of the least commonly diagnosed cancers in North America whereas it is widespread in Asia.

High-Yield Fast Fact(s):

China has the highest number of newly diagnosed gastric adenocarcinoma patients in the world.

References:

NCCN Guidelines. Gastric Cancer. Version 2.2018.
Ann Oncol. 2012 Jan;23(1):28-36.

Sample BCOP Question 3

A 30 year old female presents with bilateral adnexal masses, and is found to have stage IB, grade 3 ovarian cancer. She expresses her desire to have children in the future if possible. Which of the following treatments is most appropriate?

Bilateral salpingo-oophorectomy (BSO), then observation

BSO, then IV paclitaxel/carboplatin x 6 cycles

BSO, then intraperitoneal (IP) paclitaxel/cisplatin x 6 cycles

Total abdominal hysterectomy (TAH)/BSO, then IV and IP paclitaxel/cisplatin x 6 cycles

Answer: B

Rationale:

All ovarian cancer patients should receive surgical staging.
For stage IB ovarian cancer (tumor limited to both ovaries or fallopian tubes), the treatment of choice to preserve fertility is BSO. If the tumor is grade 3, patients should also receive adjuvant IV taxane/carboplatin for 3-6 cycles.
Observation is recommended for stage IA or IB disease that is grade 1 or 2. Adjuvant IV taxane/carboplatin x 3-6 cycles is another recommended option for grade 2.
IP chemotherapy is not recommended for stage I disease. Per NCCN guidelines, IV and IP chemotherapy is a category 1 recommendation for < 1 cm optimally debulked stage III disease and a category 2A recommendation for stage II disease.
TAH does not preserve fertility.

High-Yield Core Concept:

All ovarian cancer patients should receive comprehensive surgical staging, which differ based on fertility sparing vs. non-fertility sparing methods.
For stage IA or IB disease, adjuvant IV taxane/carboplatin x 3-6 cycles is recommended for patients with grade 2 and 3 tumors.

High-Yield Fast Fact(s):

The use of 3 vs. 6 cycles of adjuvant chemotherapy in early stage, high-risk ovarian cancer remains controversial. Chan et al. showed a significantly lower risk of recurrence after 6 vs. 3 cycles. However, Bell et al. did not show a significant difference in recurrence risk but did find increased toxicity with 6 cycles vs. 3 cycles.

Reference:

NCCN Guidelines Ovarian Cancer.
Gynecol Oncol. 2010 Mar;116(3):301-6.
Gynecol Oncol. 2006 Sep;102(3):432-9.

Sample BCOP Questions

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You Need to Pass the BCOP Exam.

HERE'S HOW OUR Q-BANK QUESTIONS CAN HELP.

✓ OUR QUESTIONS ALIGN WITH THE BCOP EXAM OBJECTIVES

✓ WRITTEN BY BOARD CERTIFIED CLINICAL PHARMACISTS

✓ COMPARE YOUR PERFORMANCE WITH PEERS

✓ TRUSTED FOR OVER A DECADE BY PHARMACISTS

Sample BCOP Q-Bank Questions

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Sample BCOP Question 1

Answer: B

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

Reference:

Sample BCOP Question 2

Answer: D

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

References:

Sample BCOP Question 3

Answer: B

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

Reference:

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