Exam 2 - Lung Cancer Weddle

Question 1

___-___ % of lung cancers are associated with smoking

Answer 1

85-90%

Question 2

______ mutations can predict sensitivity to TKI therapy, and is present in 10-15% of NSCLC

a. EGFR
b. KRAS

Answer 2

a. EGFR

Question 3

_____ mutations predict resistance to TKI’s; in adenocarcinomas, mutations are exclusive to smokers, ~10-30% of NSCLC

a. EGFR
b. KRAS
c. ALK
d. ROS-1

Answer 3

b. KRAS

Question 4

encodes a receptor kinase related to ALK; present in 1% of NSCLC

a. EGFR
b. KRAS
c. ALK
d. ROS-1

Answer 4

d. ROS-1

Question 5

it is recommended to test in 1st line metastatic setting for NSCLC

a. ROS-1 mutation
b. BRAF V600E mutation
c. EGFR mutations

Answer 5

b. BRAF V600E mutation

Question 6

T or F: PD-L1 testing is not recommended for SCLC

Answer 6

T

Question 7

adenocarcinomas, squamous and non-squamous cells, and large cells fall under which class?

a. NSCLC
b. SCLC

Answer 7

a. NSCLC

Question 8

Which NSCLC is being described below?
-most common in non-smokers
-tend to be located peripherally in the lung

a. adenocarcinoma
b. squamous
c. large cell
d. small cell

Answer 8

a. adenocarcinoma

Question 9

Which NSCLC is being described below?
-clearly related to smoking
-tend to be located centrally in lung

a. adenocarcinoma
b. squamous
c. large cell
d. small cell

Answer 9

b. squamous

Question 10

which NSCLC is being described below?
-tend to be located peripherally in the lung
-tend to be a diagnosis of exclusion

a. adenocarcinoma
b. squamous
c. large cell
d. small cell

Answer 10

c. large cell

Question 11

what is being described below?
-related to smoking
-fast growing and rapidly progressive
-can have presence of paraneoplastic syndromes

a. adenocarcinoma
b. squamous cell carcinoma
c. large cell carcinoma
d. small cell carcinoma

Answer 11

d. small cell carcinoma

Question 12

rank these in order of how common they are in types of lung cancer?
large cell, small cell, adenocarcinoma, squamous

Answer 12

adenocarcinoma (50%) > squamous (30%) > small cell (15%) > large cell (5%)

Question 13

which of the following about SCLC and NSCLC is TRUE?

a. NSCLC has a clear relationship to smoking
b. paraneoplastic syndromes are common in NSCLC
c. SCLC is not sensitive to radiation and chemo
d. NSCLC has a slower growth fraction

Answer 13

d. NSCLC has a slower growth fraction

Question 14

which of the following presents more commonly with metastases?

a. SCLC
b. NSCLC

Answer 14

a. SCLC (66% vs 50%)

Question 15

limited vs extensive stage SCLC

Answer 15

-limited = tumor is confined to hemithorax and contained in a radiation port
-extensive = not confined to hemithorax of origin, not contained in a radiation port, distant metastasis

Question 16

what is the median survival for extensive and limited stage SCLC without therapy?

Answer 16

extensive -> 6 weeks
limited -> 12 weeks

Question 17

limited stage SCLC combo therapy

Answer 17

cisplatin + etoposide + radiation

Question 18

platinum based combo chemotherapy WITHOUT radiation is preferred in _________ stage SCLC

a. limited
b. extensive

Answer 18

b. extensive

Question 19

for extensive stage SCLC, first line regimens involve carboplatin, etoposide, plus what third drug? (2 options; slide 28-30)

Answer 19

atezolizumab, durvalumab

Question 20

T or F: pembrolizumab is an option for metastatic SCLC after platinum-based chemo and at least 1 prior line of therapy, regardless of PD-1 status

Answer 20

T

Question 21

what is the most efficacious modality for tx of NSCLC?

Answer 21

surgery

Question 22

3 types of NSCLC

Answer 22

resectable, unresectable, advanced/metastatic

Question 23

T or F: neoadjuvant chemotherapy is considered standard of care for NSCLC

Answer 23

F (adjuvant, not neoadjuvant)

Question 24

how do we decide which chemotherapy will be used for NSCLC?

Answer 24

depends on histology, squamous vs non-squamous

Question 25

which adjuvant therapy is preferred for non-squamous NSCLC? a. cisplatin + pemetrexed b. cisplatin + gemcitabine c. cisplatin + docetaxel

Answer 25

a. cisplatin + pemetrexed (non-squamous = pemetrexed)

Question 26

if pt is not able to tolerate cisplatin, what can we change it to?

Answer 26

carboplatin

Question 27

two drug options for unresectable stage II/III NSCLC after concurrent chemoradiation

Answer 27

-durvalumab -osimertinib (if EGFR exon 19 deletion or L858R)

Question 28

immunotherapy option for stage III unresectable NSCLC in pts who aren't candidates for surgery or definitive chemotherapy with radiation

Answer 28

pembrolizumab

Question 29

if a pt has a targetable mutation and is PD-L1 (+), it is preferred to use the _____ therapies first and then move to immunotherapy later

Answer 29

oral

Question 30

BRAF mutations are present in ___-___ of adenocarcinomas

Answer 30

1-2%

Question 31

agent for KRAS G12C mutation

Answer 31

sotorasib

Question 32

which BRAF therapy has the following toxicities: fever, rash, and secondary skin cancers? a. dabrafenib b. trametinib

Answer 32

a. dabrafenib

Question 33

which BRAF therapy has the following toxicities: fever, rash, visual changes, retinal detachment? a. dabrafenib b. trametinib

Answer 33

b. trametinib

Question 34

drug for T790M mutation a. alectinib b. sotorasib c. pembrolizumab d. atezolizumab e. osimertinib

Answer 34

e. osimertinib

Question 35

pembrolizumab can be used in metastatic disease with PD-L1 positivity > ___ %

Answer 35

> 1% (pembro or atez)

Question 36

squamous NSCLC standard 3 drug regimen

Answer 36

carboplatin + paclitaxel + pembrolizumab

Question 37

What laboratory values do we need monitor in patients receiving immunotherapy? (6 of them)

Answer 37

CBC, CMP, TSH, free T4, amylase, lipase

Question 38

we can consider lung cancer screening for high-risk pts: age ___-___, have a ___-pack year history of smoking and are still smoking or have quit in the past ___ years, good health, and are willing to have curative lung surgery if detected

Answer 38

55-75; 30; 15

Question 39

What would be the preferred treatment regimen for someone with limited stage SCLC?

Answer 39

cisplatin + etoposide + radiation