Lung cancer Flashcards
What is SACT?
Systemic anti-cancer therapy
What are the types of lung cancer?
Non-small cell lung carcinoma (75-85%)
- Adenocarcinoma (with subgroups eg EGFR
mutation)
- Squamous cell
- Large cell, adenosquamous, carcinomas,
carcinoid
Small cell lung carcinoma (15-20%)
How is lung cancer managed based on the stage of disease?
Stage I: Surgery/Stereotactic
radiotherapy (SABR)
Stage II: Surgery (+/- SACT) or radical
radiotherapy (RT)
Stage III: Multimodality treatment
Stage IV: Palliative SACT (+/- RT)
What is the response to chemotherapy of a lung cancer if it’s <4cm?
50%
Compared to 20% in>4cm
What is the ECOG PS scale (0-5)?
Eastern Cooperative Oncology Group Performance status scale
0 - indicating fully active
1 - restricted in strenuous activity
2 - restricted in work activity but ambulatory and capable of self-care
3 - capable of limited self-care
4 - completely disabled
5 - dead
How does tumour hypoxia affect treatment?
There are no blood vessels to deliver drug treatments and no oxygen to create free-radical with radiotherapy
A problem in larger tumours
What was the QUARTZ trial
Showed no survival or QOL difference between whole brain RT and
best supportive care for multiple mets in lung cancer
Survival only 8 weeks in both arms.
How does weight loss contribute to prognosis?
Worse prognosis because it’s a form of compensation and suggests there is microscopic disease
What was the SRS trial?
This trial strongly supports the use of stereostatic radiosurgery in patients with 4-15 brain metastases to better preserve cognitive function and to minimize interruption of systemic therapy, without
compromising overall survival
What is stereostatic radiosurgery?
Uses many precisely focused radiation beams to treat tumours and other problems in the brain, neck, lungs, and liver
What are some mutations seen in Non-small cell lung cancer?
EGFR, ALK,ROS-1, KRAS
What is the class of drugs developed to treat EGFR mutations positive or ALK rearrangement positive lung cancer?
Tyrosine kinase inhibitors (TKI)
What are the chemotherapy drugs used to block PD-1?
Pembrolizumab and Nivolumab
Programmed Cell Death Protein 1 (PD-1) plays a vital role in inhibiting immune responses and promoting self-tolerance through modulating the activity of T-cells, activating apoptosis of antigen-specific T cells and inhibiting apoptosis of regulatory T cell
So blocking it kills the cancer
What are some drugs that block PDL-1?
- Atezolizumab (use with chemotherapy in extensive stage small cell lung cancer and in second-line non small cell lung cancer)
- Durvalumab (adjuvantly for 1 year duration after chemo-RT for stage 3 lung cancer)
PD-L1 acts as a pro-tumorigenic factor in cancer cells via binding to its receptors and activating proliferative and survival signalling pathways
So blocking it kills the cancer
Which lifestyle choice causes often cancer mutations ?
Non smokers or light smokers
