Exam 3 - Lung Cancer 1

Question 1

Compare small cell lung cancer (SCLC) to non-small cell lung cancer (NSCLC) characteristics?

Answer 1

smoking affects more, higher metastasis at diagnosis and lower survival without treatment, tumor growth rate faster, worse prognosis

Question 2

List the signs/symptoms of lung cancer?

Answer 2

pulmonary symptoms (cough, dyspnea, chest pain), repeat prescriptions for pneumonia/bronchitis/chronic cough, extra-pulmonary symptoms (fatigue, weight loss), superior vena cava syndrome, paraneoplastic syndromes

Question 3

List the risk factors for lung cancer?

Answer 3

smoking, asbestos and metal exposures, radiation

Question 4

What is the formula for pack years?

Answer 4

pack years = years of smoking*number of packs/day smoked

Question 5

Define neoadjuvant therapy? Adjuvant?

Answer 5

neoadjuvant = prior to surgical intervention (Now), adjuvant = after surgical intervention (After)

Question 6

What are neoadjuvant regimens for perioperative therapies in NSCLC? (3)

Answer 6

nivolumab plus platinum-based chemo for 3 cycles, pembrolizumab plus cisplatin-based chemo for 4 cycles, platinum-based chemo for 4 cycles

Question 7

What are adjuvant regimens for perioperative therapies in NSCLC? (4)

Answer 7

osimertinib, atezo/pembrolizumab, platinum based chemo for 4 cycles

Question 8

What is platinum-based chemo for non-squamous histology in NSCLC?

Answer 8

cisplatin/pemetrexed

Question 9

What are platinum-based chemo for squamous histology in NSCLC? (2)

Answer 9

cisplatin/docetaxel, cisplatin/gemcitabine

Question 10

What are platinum-based chemo for patients who are not candidates for cisplatin in NSCLC? (3)

Answer 10

carboplatin/paclitaxel, carboplatin/gemcitabine, carboplatin/pemetrexed

Question 11

What are AEs of platinum-based therapies? (6)

Answer 11

myelosuppression (carbo > cis), N/V (cis > carbo), D/C, nephro/ototoxicity (cis > carbo) and peripheral neuropathy (cis > carbo)

Question 12

What is the formula for ideal body weight (IBW)?

Answer 12

male = 50 + 2.3 (height in inches - 60), female = 45.5 + 2.3 (height in inches - 60)

Question 13

What is the formula for adjusted body weight? When is it used?

Answer 13

IBW + 0.4 (ABW - IBW); if actual body weight is 1.2 x IBW (obese patients)

Question 14

When is actual body weight used?

Answer 14

if body weight is less than IBW (underweight patients)

Question 15

What is the Cockroft-Gault equation?

Answer 15

CrCL (mL/min) = [(140 - Age) x weight in kg]/(72 x SCr) … x 0.85 if female

Question 16

What is the Calvert equation?

Answer 16

Total dose (mg) = Target AUC x (CrCL + 25)

Question 17

What is the MOA of taxanes?

Answer 17

inhibits mitosis through disruption of microtubule depolymerization

Question 18

Describe the PKPD of taxanes?

Answer 18

CYP3A4 substrate and CYP2C8 (paclitaxel only)

Question 19

What are AEs of taxanes?

Answer 19

myelosuppression, alopecia, peripheral neuropathy, mucositis, N/V/D, hypersensitivity reaction (solvent related), peripheral edema (docetaxel)

Question 20

What is the MOA of pemetrexed?

Answer 20

inhibits dihydrofolate reductase (DHFR) and thymidylate synthase (TS), thereby depleting DNA building blocks

Question 21

Describe the PKPD of pemetrexed?

Answer 21

primarily renal elimination (avoid if CrCL <45 mL/min)

Question 22

What are AEs of pemetrexed?

Answer 22

myelosuppression, rash, fatigue, N/V/D

Question 23

What are the first generation epidermal growth factor receptor (EGFR) inhibitors?

Answer 23

erlotinib, gefitinib, afatinib

Question 24

What is the second generation epidermal growth factor receptor (EGFR) inhibitor?

Answer 24

dacotaminib

Question 25

What is the third generation epidermal growth factor receptor (EGFR) inhibitor?

Answer 25

osimertinib (first line)

Question 26

What are AEs unique to third generation EGFR inhibitors (osimertinib)? (2)

Answer 26

myelosuppression, QTc prolongation

Question 27

List recommendations for EGFR inhibitor rash management?

Answer 27

sun safety (SPF25), gentle skin care (loose fitting clothing, pH neutral bath chemicals, avoidance of OTC acne products, hydrophilic creams)

Question 28

What are treatments for Grade 1 (mild) EGFR inhibitor rash management?

Answer 28

continue anticancer agent, hydrocortisone, clindamycin

Question 29

What are treatments for Grade 2 (moderate) EGFR inhibitor rash management?

Answer 29

continue anticancer agent, hydrocortisone, doxy/minocycline

Question 30

What are treatments for Grade 3 (severe) EGFR inhibitor rash management?

Answer 30

delay treatment for 1-2 weeks, continue Grade 1 and 2 interventions AND prednisone x7days