Lung Cancer Therapeutics

Question 1

what are the 5 main mutations that can guide lung cancer therapy regimens

Answer 1

EGFR mutations
KRAS mutations
ALK inhibition
ROS-1 mutations
BRA V600E

Question 2

what are the two main lung cancer groups

Answer 2

NSCLC
SCLC

Question 3

describe SCLC

Answer 3

clear relationship to smoking
paraneoplastic syndromes common
rapid cell growth fraction
highly sensitive to radiation and chemotherapy

Question 4

which lung cancer is highly sensitive to radiation and chemo

Answer 4

SCLC

Question 5

what is a complication of therapy for SCLC

Answer 5

cisplatin complications (N/V, nephrotoxicity, ototoxicity, neuropathy
radiation complications

Question 6

is surgery an option in SCLC

Answer 6

no

Question 7

what is the intent in limited stage SCLC

Answer 7

curative intent

Question 8

what is 1st line treatment for limited stage SCLC

Answer 8

combo chemo + radiation
cisplatin + etoposide w/ radiation

Question 9

is maintenance chemo an option for limited stage SCLC

Answer 9

no there is no benefit

Question 10

what is the intent with extensive stage SCLC

Answer 10

not curative. prolong survival

Question 11

what is the preferred treatment option in extensive SCLC

Answer 11

platinum based therapy w/o radiation
-cisplatin/carboplatin + etoposide/irinotecan

Question 12

what is first line immunotherapy for extensive SCLC

Answer 12

carboplatin + etoposide + durvalumab OR atezolizumab

Question 13

is maintenance chemotherapy acceptable in extensive SCLC

Answer 13

yes

Question 14

what is a treatment option for metastatic SCLC patients who have progressed on or after platinum chemo and at least 1 prior line of therapy

Answer 14

pembrolizumab

Question 15

how to treat relapse of extensive SCLC

Answer 15

> 6 months: original regimen +/- mab
<=6 months: topotecan, clinical trial, or pembrolizumab

Question 16

what are the two main forms of NSCLC

Answer 16

adenocarcinoma (non-smokers)
squamous (smokers)

Question 17

what is the best treatment for NSCLC

Answer 17

surgery

Question 18

what is the treatment for resectable NSCLC

Answer 18

1. surgery to remove
2. adjuvant chemo based on histology

Question 19

what is the chemo regimen for resectable non-squamous NSCLC

Answer 19

cisplatin + premetrexed

Question 20

what is the chemo regimen for resectable squamous NSCLC

Answer 20

cisplatin + gemcitabine
cisplatin + docetaxel

Question 21

if a patient is unable to tolerate cisplatin, what can be substituted

Answer 21

carboplatin

Question 22

what is the treatment regimen for unresectable NSCLC

Answer 22

chemo + radiation + consolidation w/ mab

Question 23

what is the intent of treatment for unresectable NSCLC

Answer 23

stage IIIB/IV disease is palliative not curative

Question 24

for patients with unresectable NSCLC who are not candidates for surgery or chemo + radiation what is the preferred treatment option

Answer 24

pembrolizumab

Question 25

what is the chemo regimen for unresectable NSCLC

Answer 25

cisplatin + paclitaxel cisplatin + gemcitabine cisplatin + docetaxel

Question 26

what drug should be followed by chemo regimen and for how long

Answer 26

Durvalumab and for 12 months for maintenance/consolidation therapy

Question 27

what should be checked in all advance metastatic adenocarcinomas (non-squamous)

Answer 27

mutational status and PD-L1 status

Question 28

what is first line for metastatic adenocarcinomas with a positive mutation

Answer 28

TKIs first then immunotherapy

Question 29

what should be used with an EGFR + mutation (exon 19, exon 21, L858R mutation, T790M mutation)

Answer 29

Osimertinib

Question 30

what are side effects with Osimertinib

Answer 30

cardiomyopathy, RASH

Question 31

what should be used with a BRAF + mutation

Answer 31

Dabrafenib + Trametinib

Question 32

what are side effects of dabrafenib + trametinib

Answer 32

fevers, rash, visual changes, retinal detachment

Question 33

what should be used in K-RAS G12C mutation

Answer 33

Sotorasib used after platinum based chemo +/- immunotherapy

Question 34

what is a side effect of Sotorasib

Answer 34

increased LFTs

Question 35

what is first line in metastatic adenocarcinoma with no mutation or oral chemo has been exhausted

Answer 35

Pembro or Carbo + Pem ^2

Question 36

what is the treatment for mutation negative PD-L1 negative metastatic adenocarcinom

Answer 36

carboplatin + pemetrexed + pembrolizumab

Question 37

what is first line for metastatic squamous cell cancer

Answer 37

Pembrolizumab + Carboplatin + Paclitaxel

Question 38

what is the treatment for a patient with a CI to immunotherapy with metastatic squamous cell cancer

Answer 38

platinum doublet regardless of PD-L1 status

Question 39

what are the toxicities to immunotherapy

Answer 39

CHEN-P Colitis Hepatitis Endocrine (thyroid/pituitary) Nephritis Pneumonitis

Question 40

what 6 labs should be monitored for patients receiving immunotherapy

Answer 40

CBC diff CMP (renal, liver, glucose) TSH and Free T4 Amylase and lipase

Question 41

who should consider lung cancer screening

Answer 41

patients at high risk 55-74 w/ 30 pack year of smoking and still in good health and willing to have curative surgery