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Heme/Onc > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the risk factors for lung cancer?

A

Tobacco smoking and exposure
Age: rare in less than 40 yo
Genetics
Occupational/ Environmental exposures

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2
Q

What are the genetic mutations responsible for lung cancer?

A 
p53
KRAS
EGFR
MYC
c-KIT
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3
Q

What are occupational/ environmental exposures?

A 
Radiation therapy
Second-hand smoke
Asbetos
Radon
Metals
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4
Q

Smoking causes what type of lung cancer?

A

SCLC

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5
Q

The doubling time/growth rate is rapid in which type of lung cancer?

A

SCLC

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6
Q

What is the general treatment type for SCLC?

A

Chemotherapy

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7
Q

Which type of lung cancer is paraneoplastic syndromes common?

A

SCLC

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8
Q

What are the staging criteria for SCLC?

A

Limited

Extensive

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9
Q

What are paraneoplastic syndromes?

A

Appear unrelated to cancer but are sx of the cancer

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10
Q

What is the screening for lung cancer?

A

Evaluation of individual risk assessment

Low dose spinal CT in high risk patients who are potential candidates for treatment

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11
Q

What are considered high risk patients for lung cancer?

A

Age 55-74: smoking at least 30 packs/yr, or smoking cessation within 15 years
Age 50+: 20-29 pack/yr, with one additional RF

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12
Q

What are pulmonary and thoracic s/sx?

A 
Cough
Dyspnea
Chest pain
Sputum production
Hemoptysis
Pleural effusion
Hoarseness
Superior vena cava syndrome
Dysphagia
Wt loss
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13
Q

What are sx of metastatic involvement?

A 
Neurologic: paralysis, neurologic deficits, spinal cord compression
Bone pain
Liver dysfunction
Adrenal dysfunction
Lymphadenopathy
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14
Q

What are paraneoplastic syndromes?

A 
Hypercalcemia
Cushing syndrome
Vasopressin --> SIADH
Immune mediated
Eaton-Lambert syndrome
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15
Q

How do we diagnose lung cancer?

A

Hx, PE, Lab testing
PFT
Radiography
Biopsy

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16
Q

What type of biopsies are used to test for lung cancer?

A 
TBNA
Thoracentesis
Mediastinoscopy
VATS and open surgical biopsy
EBUS - guided forceps biopsy
EUS - guided biopsy
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17
Q

What is limited stage SCLC?

A

Lung cancer that can be safely treated with definitive radiation doses

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18
Q

What is extensive stage SCLC?

A

Stage IV

Tumor/nodal volume too large to fit in a tolerable radiation plan

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19
Q

What are poor prognostic factors for SCLC?

A

ECOG > 3
Wt loss
Markers associated with bulky disease

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20
Q

What is the goal of limited stage SCLC?

A

Cure

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21
Q

What is treatment for limited stage SCLC with good performance status?

A

Radiation concurrently w/chemotherapy

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22
Q

What is the treatment for limited stage SCLC with poor performance status?

A

Chemo +/- radiation

23
Q

What is the goal of extensive stage SCLC?

A

Include palliation, prolong life (very rarely curable)

24
Q

What is the treatment of extensive stage SCLC with good performance status?

A

Chemo +/- radiation to sx metastatic sites

25
Q

What is the treatment of extensive stage SCLC with poor performance status?

A

Supportive care

26
Q

When is prophylactic cranial irradiation used?

A

If complete/partial response attained

If still good performance status and minimal comorbidities

27
Q

What are the preferred drugs of choice for SCLC?

A

Cisplatin and Etoposide (w/radiation)

Carboplatin and Etoposide

28
Q

What do we do with the therapy if a patient with SCLC has a relapse w/in 6 months with ECOG 0-2?

A

+/- ipilimumab

Topotecan, Irinotecan, Temozolomide, Paclitaxel, CAV, gemxitibine, docetaxel, etopodisde, vinorelbine, nivolumab

29
Q

What do we do if a patient has a relapse of SCLC after 6 months?

A

Retry original regimen

30
Q

What are types of supportive care for SCLC?

A 
Pain management
N/V
MGFs
Radiation therapy toxicities
Paraneoplastic syndrome tx
31
Q

Which stages of NSCLC are resectable?

A

I, II, III

32
Q

What are treatment options for stages I, I, and III NSCLC?

A

Srugery +/- adjuvant radiation (if positive margins)

Adjuvant chemotherapy/ chemoradiation

33
Q

If the cancer is unresectable in stage IIB or IIIA, what are treatment options?

A

Chemoradiation

34
Q

What are the drugs that are used in EGFR mutation positive NSCLC patients?

A

Erlotinib
Afatinib
Gefitinib

35
Q

What are the drugs used in ALK mutation positive NSCLC patients?

A

Alectinib
Crizotinib
Ceritinib

36
Q

What is the drug used for PD-L1 expression positive NSCLC patients?

A

Pembrolizumab

37
Q

What drugs are used for adenocarcinoma with negative NSCLC mutations?

A

Doublet chemo +/- bevacizumab

38
Q

What drugs are used for squamous cell NSCLC?

A

Doublet chemotherapy

39
Q

What drugs are used with early stage adjuvant chemotherapy for NSCLC?

A

Cisplatin plus one of the following

Vinorelbine, etoposide, vinblastine, gemcitabine, paclitaxel, pemetrexed

40
Q

Which histology is pemetrexed used with?

A

Non-squamous cell

41
Q

Why would carboplatin be used in place of cisplatin for NSCLC?

A

Decrease toxicity

42
Q

What is considered advanced/metastatic disease?

A

Stage IV or IIIB with pericardial effusions or supraclavicular lymph node involvement

43
Q

If a patient has advanced metastatic NSCLC disease with an EGFR mutation, what medication can be initiated?

A

Erlotinib
Afatinib
Gefitinib

44
Q

If a patient has advanced metastatic NSCLC disease with an ALK mutation, what medication can be initiated?

A

Alectinib
Crizotinib
Ceritinib

45
Q

If a patient has advanced metastatic NSCLC disease with a PD-L1 expression, what medication can be initiated?

A

Pembrolizumab

46
Q

If a patient has advanced metastatic NSCLC disease with no mutations (adenocarcinoma), what medication can be initiated?

A

Doublet chemotherapy +/- bevacizumab

47
Q

If a patient has advanced metastatic NSCLC disease with squamous cell histology, what medication can be initiated?

A

Doublet chemotherapy

48
Q

What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on
doublet + bevacizumab?

A

Bevacizumab

49
Q

What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on cisplatin/pemetrexed?

A

Pemetrexed

50
Q

What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on Bevacizumab/pemetrexed with cisplatin or carboplatin?

A

Bevacizumab + pemetrexed

51
Q

If the patient has advanced/metastatic NSCLC and their initial therapy was platinum based doublet, what drug can be used as a switch agent?

A

Pemetrexed

52
Q

What drugs are affected by EGFR mutations?

A

Erlotinib
Afatinib
Gefitinib

53
Q

What drugs are affected by KRAS mutations?

A

Erlotinib

Afatinib

54
Q

What drugs are affected by EML4-ALK mutations?

A

Alectinib
Crizotinib
Ceritinib

Heme/Onc (20 decks)

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