Exam 2: Lung Cancer Flashcards
(49 cards)
1
Q
EGFR Mutations: Lung Cancer
A
- can predict sensitivity to TKI therapy
2
Q
KRAS mutations: Lung Cancer
A
- can predict resistance to TKIs
- exclusive to smokers
3
Q
ALK inhibition: Lung cancer
A
- present in non/light smokers, younger age, adenocarcinoma
4
Q
ROS-1 mutations: Lung Cancer
A
- encodes receptor kinase related to ALK
- present in never/light smoker, adenocarcinomas, younger patients
5
Q
BRAF V600E
A
- typically current or former smokers
- recommended to test in 1st line metastatic setting for NSCLC
6
Q
PD-L1 Status
A
- patients with EGFR, ALK, or ROS-1 mutation rearrangements typically done have PD1 expression
- testing not recommended for SCLC
7
Q
When to check PD-L1 status
A
1st line metastatic setting setting
8
Q
NSCLC Histology Adenocarcinoma
A
- 50% adenocarcinoma
- most common in non-smokers
- tend to be located peripherally in the lung
9
Q
NSCLC Histology Squamous
A
- 30%
- clearly related to smoking
- tend to be located centrally in lung
10
Q
NSCLC Histology Large Cell
A
- 5%
- tend to be located peripherally in the lung
- tend to be a diagnosis of exlusion
11
Q
SCLC Histology
A
- 15%
- related to smoking
- fast growing and rapidly progressive
- can have presence of paraneoplastic syndrome
12
Q
NSCLC Characteristics
A
- slower growth fraction
- moderatly sensitive to radiation
- marginal sensitivity to chemo
- 50% present with metastases
13
Q
SCLC Characteristics
A
- clear relationship to smoking
- paraneoplastic syndromes common
- rapid cell growth fraction
- highly sensitive to radiation and chemotherapy
- two thirds present with matastases
14
Q
Presentation of Lung Cancer
A
- very nonspecific
- cough
- spitting up blood
- dyspnea
15
Q
SCLC Limited Stage
A
tumor is confined to hemithorax and contained in a radiation port
16
Q
SCLC Extensive Stage
A
- tumor not confined to hemithorax or origin
- not contained in a radiation port
- distant metastasis
17
Q
Is surgery a therapeutic option in SCLC
A
no
18
Q
Limited Stage SCLC treatment
A
- curative intent
- radiation + combo chemo
- radiation given concurrently daily
19
Q
Chemo regimen in limited stage SCLC
A
- platinum doublet
- Cisplatin and Etoposide w/daily radiation
20
Q
Extensive stage SCLC treatment
A
- rarely curative
- platinum based combo chemo without radiation
- cisplatin or carboplatin-based combo
- etoposide or irinotecan
21
Q
When is radiation appropriate for extensive stave SCLC
A
- prophylactic cranial radiation if a patient achieves a response in the chest
- if brain metastases present, whole brain radiation should be given
- if symptomatic, whole brain radiation should be started prior to chemo
- if asymptomatic, initiate radiation after chemo
22
Q
Immunotherapy SCLC Extensive Stage
A
Atezolizumab + Carboplatin + Etoposide
Durvalumab + Carboplatin + Etoposide
23
Q
Platin-based regimen toxicity
A
- myelosupression
- nephrotoxicity
24
Q
PD-1 Inibitors SCLC
A
- option for metastatic SCLC patients who have progressed on or after platinum based chemo and at least 1 prior line of therapy
- regardless of PD-1 status
25
NSCLC Treatment Modalities
- moderately sensitive to radiation
- low sensitivity to chemo
- Surgery is most efficacious
- radiation for early stage when surgery cannot be performed
26
Neoadjuvant Treatment of Resectable NSCLC
- nivolumab + platinum doublet with tumors ≥ 4 cm or node positive and no contraindications
27
Preferred non squamous resectable NSCLC Adjuvant Therapy Option
- Cisplatin + pemetrexed
28
Preferred squamous NSCLC resectable Treatment
Cisplatin +
- gemcitabine
- docetaxel
- vinorelbine
- etop
29
Alternative adjuvant NSCLC resectable therapy option for those not able to tolerate cisplatin
Carboplatin +
- paclitaxel
- gemcitibine
- Pemetrexed (nonsquamous only)
30
ALK positive and early stage resectable NSCLC
- alectinib
31
EGFR mutation exon 19/21 resectable NSCLC treatment
osimertinib
32
Additional adjuvant resectable NSCLC treatment
- atezolizumab
- pembrolizumab
33
Treatment for Unresectable Nonsquamous NSCLC (Stage IIIB/IV)
- treatment considered palliative
- platinum doublet chemo + radiation
- cisplatin/carboplatin + pemetrexed/paclitaxel/etop
34
Treatment for Unresectable squamous NSCLC (Stage IIIB/IV)
- Paclitaxel + carboplatin (fewer toxicities)
- cisplatin + etoposide
35
Stage III unresectable NSCLC Immunotherapy
- pembrolizumab an option for non-candidates for surgery or chemo/radiation
- durvalumab for disease that has not progressed following chemo/radiation
36
Utilizing TKIS in metastatic adenocarcinoma NSCLC
- if patient has targetable mutation and is PD-L1+, it is preferred to use the oral therapies first and then move to immunotherapy
37
EGFR Targeted therapies in metastatic adenocarcinoma NSCLC
Osimertinib (T790 Mutation)
38
BRAF Targeted therapies in metastatic adenocarcinoma NSCLC
Dabrafenib + Trametinib
39
KRAS G12C Targeted therapies in metastatic adenocarcinoma NSCLC
Sotorasib
40
If no mutation found in metastatic NSCLC adenocarcionma or if targeted oral chemo have been exhausted for a positive mutation
- check PDL1 status
- if positive, Keytruda
41
Mutation negative nonsquamous NSCLC
- carboplatin + pemetrexed + pembrolizumab
42
Treatment for Metastatic squamous NSCLC if no contraindication to immunotherapy
- pembro OR
- pembro + chemo OR
- Atezolizumab or Nivolumab or Cemiplimab-rwlc
43
Treatment for Metastatic squamous NSCLC if contraindication to immunotherapy
- platinum doublet regardless of PDL1 status
44
First line for Squamous Cell NSCLC
- platinum doublet
45
Carboplatin is typically paired with
- gemcitabine OR
- paclitaxel OR
- nab-paclitaxel OR
- Docetaxel
46
Squamous NSCLC standard 3 drug regiment
- pembro + carboplatin + paclitaxel (or albumin bound paclitaxel)
47
Next line of therapy for metastatic squamous cell NSCLC
- TKI if positive
- Immunotherapy or non-platinum therapy
48
Immunotherapy toxicities
- rare and serious
- pneumonitis
- colitis
- hepatitis
- nephritis
- endocrine (thyroid/pituitary)
49
Lung Cancer Screening
- can consider screening in patients considered high risk
- no effective screening methods
- false positives
- no cost-effectiveness data
