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J:Breast Cancer > Lung Cancer > Flashcards

Lung Cancer Flashcards

(58 cards)

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1
Q

What are the risk factors for lung cancer? How do you calculate PACK years?

A

Smoking and Second Hand Smoke
Asbestos Exposure
Radiation
Air Pollution

Pack year = (yr smoking) * (packs/day)

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2
Q

What are the neoadjuvant therapies for NSCLC?

A

Nivolumab, Pembrolizumab, Durvalumab
PLUS
Platinum Based Chemo x 4 cycles.

After can continue immunotherapy alone as adjuvant.
If patient is not candidate for immunotherapy –> Platinum Alone.

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3
Q

What are the adjuvant therapies for NSCLC?

A

Osimertinib QD (eGFR +)
Alectinib BID (ALK +)
Atezolizumab
Pembrolizumab
Nivolumab
Durvalumab
Platinum Chemo (If not candidate for above)

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4
Q

What is the platinum based chemo for non-squamous NSCLC?

A

Cisplatin/Pemetrexed
Every 21 days x4

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5
Q

What is the platinum based chemo for squamous NSCLC?

A

Cisplatin/Docetaxel OR
Cisplatin/Gemcitabine
Every 21 days x4

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6
Q

If a patient has NSCLC, and can not tolerate cisplatin, what are the next options?

A

Carboplatin/Paclitaxel
Carboplatin/Gemcitabine
Carboplatin/Pemetrexed (non-squamous)

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7
Q

Pemetrexed should only be used if _______.

A

The tumor is non-squamous

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8
Q

Platinum Chemotherapy ADEs (sort by cisplatin better vs carbo)

A

Cisplatin Better:
–> Myelosuppression

Carboplatin Better:
—> Nephrotoxicity
—-> Ototoxicity
—-> Peripheral Neuropathy
—-> N/V

Diarrhea and Constipation is about the same for both

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9
Q

How to calculate carboplatin dose

A
  1. IBW Equation (50 or 45.5 +2.3(ht over 5 ft)
    –> Use Adj BW if ABW 1.2 X IBW (Adj = IBW + 0.4 (ABW-IBW)
    –> Use actual BW if ABW less than IBW
  2. Calculate CrCl
  3. Total Dose = Target AUC * (CrCl -25)
    —> Max CrCl = 125
    —> Max dose = Target AUC * 150
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10
Q

Adjusted Body Weight Equation

A

ADJ BW = IBW + 0.4 (ABW-IBW)

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11
Q

Paclitaxel and Docetaxel are ________

A

Taxanes
—> Inhibit Microtubule depolymerization.

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12
Q

What are the adverse effects of Taxanes?

A

T: iredness
A: Alopecia
X: Xtra Pain
A: Affected Nerves (Neuropathy)***** —-> Paclitaxel&raquo_space;>
N: Neutropenia
E:mesis
S: Stomatitis + Mucositis

Peripheral Edema (Docetaxel»>) —> Premed with Dexamethasone
Hypersensitivity –> Premed with H2RA, Dexa, Benadryl

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13
Q

How does Pemetrexed Work? How is it cleared?

A

Pemtrexed = DHRFR and TH inhibitor –> Depletes DNA building blocks

Renally Cleared
—> Avoid NSAIDs (decrease CL)
—> Avoid <45 ml/min

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14
Q

How should Pemtrexed be supplemented?

A

Folate + B12

Pretreat before, day of, and after with Dexamethasone 4 mg BID

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15
Q

Who are eGFR mutations common in?

A

Adenocarcinomas + Nonsmokers

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16
Q

What drug is used to overcome eGFR resistance?

A

Amivantamab

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17
Q

Erlotinib, Gefitinib, Afatinib are _______

A

First Gen eGFR inhibitors

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18
Q

Dacomitinib is a ________

A

2nd Gen eGFR inhibitor

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19
Q

Osimertinib is a _______

A

3rd Gen eGFR inhibitors

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20
Q

Why is Osimertinib the preferred eGFR inhibitor?

A

Significant improve PFS and OS
Improved CNS activity
Better Tolerability

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21
Q

Lazertinib is only approved with?

A

Amivantamab
Lazertinib = 3rd gen eGFR inhibitor

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22
Q

Rash is a major side effect of EGFR inhibitors, how can this be prevented?

A

SPF25 Sunblock
Loose fitting clothes, pH neutral bath, avoidance of hot showers, avoid OTC acne products, hydrophilic creams.

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23
Q

eGFR grade 1 rash treatment

A

Continue Therapy
Hydrocortisone 2.5% OR Clindamycin 1%

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24
Q

eGFR Grade 2 rash treatment

Study These Flashcards
A

Continue therapy
Hydrocotisone 2.5%
AND Doxycycline or Minocycline 100 mg PO BID

25
eGFR Grade 3 Rash Treatment
Hold Therapy 1-2 weeks, Dose Reduce per PI Do previously recommended steps. AND Prednisone 0.5 mg/kg QD x7 days
26
Crizotinib and Ceritinib are _______
1st Gen ALK Inhibitors
27
Alectinib and Brigatinib are _______
2nd Gen ALK Inhibitors
28
Lorlatinib and Ensartinib are ______
3rd Gen ALK inhibitors
29
Which ALK inhibitor has improved potency and penetration of the BBB?
Lorlatinib
30
Kras mutations are most associated with what?
Smoking
31
When are KRAS inhibitors indicated?
KRAS G12 mutation AFTER receipt of one therapy.
32
Sotorasib and Adagrasib are _______
KRAS inhibitors.
33
What is the major drug interaction of Sotorasib and Adagrasib?
PGP (These are strong PGP Inhibitors.)
34
What are the major ADE of Adagrasib?
1. Renal Impairment 2. Edema 3. QT prolongaton 4. Pneumonitis
35
How is a metastatic patient with PDL1 >50% managed?
Immunotherapy single agent or with chemo
36
How is a metastatic patient with PDL1 1-49% managed?
Immunotherapy + chemo
37
How is a metastatic patient with PDL1 <1% managed?
Immunotherapy + Chemo
38
What are the immunotherapies for NSCLC?
Pembrolizumab, Atezolizumab, Cemiplimab
39
What are the metastatic NSCLC chemoregimens?
1. Carbo + Paclitaxel + Pembrolizumab 2. Cis/Carb + Pemetrexed + Pembrolizumab (Non-squamous) 3. Cis/Carb + Pemetrexed + Cemiplimab (Non-squamous) 4. Cis/Carb + Paclitaxel + Cemiplimab
40
What would be the second line NSCLC treatment for a patient who did not previously receive immunotherapy?
Give Checkpoint inhibitor (Pembro, Atezo, Cemiplimab)
41
What would be the second line NSCLC treatment for a patient who did receive a previous immunotherapy?
1. Docetaxel + Ramucirumab 2. Docetaxel 3. Gemcitabine 4. Albumin Bound Paclitaxel 5. Pemtrexed (non-squamous) 6. Fam-Trastuzumab derxutecan
42
How do we manage patients on immunotherapy with Grade 1 ADEs?
Continue therapy
43
How do we manage patients on immunotherapy with grade 2 ADEs?
Hold and consider corticosteroids (0.5-2 mg/kg/day until resolution to grade 1 then taper over 1 month)
44
How do we manage patients on immunotherapy with grade 3 ADE?
Hold and give corticosteroids (0.5-2 mg/kg/day until resolution to grade 1 then taper over 1 month)
45
In immunotherapy ADE, what should be done if refractory to steroid?
Add Mycophenolate or Infliximab
46
Bevacizumab and Ramicurumab are ______
VEGF inhibitors
47
What are the VEGF inhibitor ADEs?
*HYPERTENSION* ---> Stroke Risk Epistaxis + Bleeds GI Perforation Proteinuria Diarrhea --> Ramucirumab`
48
When should we avoid VEGF inhibitors?
Recent Hemoptysis Those on Anticoagulation for new VTE Recent Surgical procedure
49
In addition to the usual VEGFi contraindications, when should bevacizumab be avoided?
Squamous NSCLC
50
What is the first line chemo in the limited stage of SCLC?
Cis/Carbo + Etoposide + Radiation +/- Durvalumab
51
What is the first line chemo in the extensive stage of SCLC?
1. Carboplatin + Etoposide + Atezolizumab 2. Carb/Cis + Etoposide + Durvalumab
52
What are Etoposide and Topotecan?
Topoisomerase Inhibitors Etoposide = Topo II Topotecan = Topo I
53
When should Topotecan be dose adjusted?
CrCl 20-39 Avoid less than 20
54
What is the mechanism of Lurbinectedin?
Alkylates DNA
55
What are the ADEs of Lurbinectedin?
Fatigue, AST/ALT elevations, Extravasation, Nausea, Myelosuprresion, Increased SCr, Musculoskeletal pain
56
How should Lurbinectedin be pretreated?
Dexamethasone ---> decrease Liver enzyme elevation 5-HT3 Antagonists ---> Antiemetic purposes
57
What is tarlatamab, how is it dosed?
Bi-Specific T-cell engager--> directs T-cells to cancer cells expressing delta-like ligand 3. 1 mg on day 1, then 10 mg on day 8, then 10 on day 15.
58

J:Breast Cancer (6 decks)

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