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Melanoma — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

HardMelanoma & SkinMelanomaSCE Medical Oncology

A patient with hepatocellular carcinoma starts nivolumab with baseline AST 2 times the upper limit of normal (ULN). Four weeks later AST is 6 times ULN, bilirubin is normal and viral and radiological causes have been excluded. According to the current UK SmPC table for immune-related hepatitis in HCC, what is the appropriate nivolumab action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Withhold nivolumab until values return to baseline and corticosteroid management, if needed, is complete

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

D is correct: with baseline AST 1–3 times ULN, a rise to more than 5 but no more than 10 times ULN triggers withholding. A undertreats probable immune hepatitis; B is reserved in this table for AST/ALT above 10 times ULN or bilirubin above 3 times ULN; C is invalid because checkpoint inhibitors are not dose-reduced; E risks worsening immune toxicity.

Reference: OPDIVO UK summary of product characteristics (Updated 20 July 2026): https://www.medicines.org.uk/emc/product/6888/smpc