skip to main content

NSCLC Surveillance — SCE Medical Oncology MCQ

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

HardLung CancerNSCLC SurveillanceSCE Medical Oncology

Three months after completing two years of pembrolizumab, a patient in radiological remission develops severe fatigue, postural dizziness and hyponatraemia. There is no new tumour on CT. What is the safest next step?

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

Reveal the answer and explanation

Correct answer: D — Check paired cortisol and ACTH urgently, treating as adrenal crisis if clinically suspected

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

A is correct. The UK pembrolizumab product information explicitly warns that immune-mediated reactions may occur after the final dose. Fatigue, postural symptoms and hyponatraemia require urgent adrenal-axis assessment and consideration of hypophysitis or primary adrenalitis; if crisis is suspected, hydrocortisone and fluids must not wait for test results. Negative tumour imaging does not make the symptoms benign, but nor do they prove relapse. Delayed toxicity is not an indication to restart treatment. Follow-up after fixed-duration immunotherapy must therefore remain symptom-responsive rather than relying only on scheduled cancer scans.

Reference: Keytruda UK Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/2498/smpc