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703 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Which type of lung cancer leads to a shorter life expectancy due to rapid tumor growth and metastasis? (NSC vs SC)

A

SCLC

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2
Q

What are common metastatic sites of lung cancer?

A
  • Contralateral lung
  • Lymph nodes
  • Liver
  • Adrenal glands
  • Bone
  • CNS*
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3
Q

What are unique symptoms of lung cancer?

A
  • SVC syndrome
  • Neurologic symptoms due to CNS metastases
  • Paraneoplastic syndromes (SIADH, hypercalcemia)
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4
Q

How do you calculate pack years?

A

Years of smoking * Number of packs/day smoked
(1 pack = 20 cigarettes)

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5
Q

Who should we screen for long cancer?

A
  • Adults 50-80 years
  • Smokers who quit within the last 15 years AND have a 20+ pack-year smoking history
  • Without disqualifying comorbidity that shortens life expectancy
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6
Q

How do we treat resectable stage 1 NSCLC?

A

Surgical resection

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7
Q

How do we treat unresectable stage 1 NSCLC?

A

RT

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8
Q

How do we treat resectable stage 2 NSCLC?

A
  1. Surgical resection +/- neoadjuvant
  2. Adjuvant therapy
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9
Q

How do we treat unresectable stage 2 NSCLC?

A

Chemo + RT

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10
Q

How do we treat resectable stage 3 NSCLC?

A
  1. Surgical resection + neoadjuvant therapy +/- RT
  2. Adjuvant therapy
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11
Q

How do we treat unresectable stage 1 NSCLC?

A
  1. Chemo + RT
  2. Durvalumab maintenance
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12
Q

What is the preferred platinum chemo regimen for non-squamous histology?

A

Cisplatin/pemetrexed

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13
Q

Which drug can only be used for non-squamous histology?

A

Pemetrexed

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14
Q

Which people are not candidates for cisplatin?

A

Poor performance status or significant comorbidities

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15
Q

Which consideration does the Calvert equation take into account while dosing carboplatin?

A

Renal function

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16
Q

Which specific ADE is more common in carboplatin than cisplatin?

A

Thrombocytopenia

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17
Q

What are side effects of platinum-based chemotherapy agents?

A
  • Myelosuppression
  • N/V
  • Diarrhea/constipation
  • Nephrotoxicity
  • Ototoxicity
  • Peripheral neuropathy
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18
Q

Which body weight should be used for obese patients?

A

AdjBW

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19
Q

What is the Calvert equation?

A

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

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19
Q

How do you calculate the maximum carboplatin dose?

A

Target AUC x 150 mL/min

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20
Q

What are side effects of taxanes (docetaxel, paclitaxel) that we should tell patients about?

A

Alopecia and peripheral neuropathy

20
Q

What is the maximum CrCl that should be used in the Calvert equation?

A

125 mL/min

21
Q

What should we give to patients taking taxanes to prevent hypersensitivity reactions?

A

Dexamethasone, famotidine, Benadryl

22
Q

Why do we give dexamethasone with pemetrexed?

A

To prevent skin rash

23
Q

Which ADEs are unique to osimertinib compared to other EGFR inhibitors?

A
  • QTc prolongation
  • Mouth sores
  • Fatigue
24
Q

What sorts of dermatologic management should be used for patients on EGFR inhibitors?

A
  • SPF 25 sunscreen
  • Gentle skin care (avoid OTC acne products)
  • Topical or systemic antibiotics/steroids
25
Q

What should we do if a patient develops grade 3 rashes on an EGFR inhibitor?

A
  • Delay treatment 1-2 weeks
  • Consider dose reduction
  • Continue rash management and add prednisone 0.5 mg/kg for 7 days
26
Q

What are our preferred ALK inhibitors?

A

Brigatinib, Alectinib, Lorlatinib

27
Q

What are the common side effects between the preferred ALK inhibitors?

A
  • Muscle/joint pains
  • Fatigue
28
Q

Why does lorlatinib have multiple neurological side effects?

A

It has more CNS penetration (common site of lung cancer metastasis)

29
Q

What are side effects of brigatinib?

A
  • Diarrhea
  • Fatigue
  • Lung disease
  • Myalgia
  • HTN
30
Q

What are side effects of alectinib?

A
  • Constipation
  • Fatigue
  • Liver problems
  • Peripheral edema
  • Myalgia
  • Anemia
31
Q

What are side effects of lorlatinib?

A
  • Fatigue
  • Peripheral edema
  • Mood problems
  • Arthralgia
  • Dyslipidemia
32
Q

Which drug treats the exon 20 mutation?

A

Amivantamab

33
Q

(EGFR/KRAS) mutations are more commonly associated with cigarette smoking

A

KRAS

34
Q

Which drugs are approved for advanced or metastatic NSCLC with KRAS G12C mutation AFTER 1 prior therapy?

A

Sotorasib and Adagrasib

35
Q

Which KRAS inhibitor requires an acidic environment?

A

Sotorasib

36
Q

What are the monotherapy agents used for metastatic non-targetable NSCLC?

A

Pembrolizumab, Atezolizumab, Cemiplimab

37
Q

What is second line treatment for metastatic non-targetable NSCLC if a checkpoint inhibitor has been tried?

A

Docetaxel + Ramucirumab

38
Q

What is second line treatment for metastatic non-targetable NSCLC if a checkpoint inhibitor has not been tried?

A
  • Pembrolizumab
  • Nivolumab
  • Atezolizumab
39
Q

How should we treat grade 1 immunologic ADEs?

A

Continue

40
Q

How should we treat grade 2 immunologic ADEs?

A

Hold immunotherapy and consider steroids

41
Q

How should we treat grade 3 immunologic ADEs?

A

Hold immunotherapy and give prednisone 0.5-2 mg/kg/day or equivalent until resolution to grade 1, then taper for at least 1 month

42
Q

How should we treat immunologic ADEs that are not resolved by steroids?

A

Mycophenolate, infliximab

43
Q

What VEGF inhibitors can we use for NSCLC?

A

Bevacizumab, ramucirumab

44
Q

How do we treat limited-stage SCLC?

A

Cisplatin/carboplatin + etoposide + concurrent RT

45
Q

How do we treat extensive-stage SCLC?

A

Carboplatin + etoposide + atezolizumab/durvalumab

Cisplatin + etoposide + durvalumab

46
Q

What are second line options for SCLC?

A
  • Topotecan
  • Lurbinectedin
  • Clinical trial
47
Q

What is the major side effect of etoposide, topotecan*, and lurbinectedin?

A

Myelosuppression

48
Q

What are unique side effects of lurbinectedin?

A

Fatigue, hepatic enzyme elevations, extravasation, nausea (pretreat with zofran)

703 (12 decks)

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