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Thoracic COPY > NSCLC > Flashcards

NSCLC Flashcards

1
Q

maintenance therapy

A

only indicated for bevacizumab and pemetrexed, hasn’t been shown for taxol in SCC

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2
Q

ALK

A

ALK (ch2) with EML4 ch5–> do not confer increased sensitivity to chemo–> occur in never/light smokers, adenos, younger age; not associated with ethnicity or sex. 40% positive in never-smoker EGFR wild type

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3
Q

pulmonary reserve

A

FVC<1L contraindicated

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4
Q

post-op RT

A

only if N2 involvement, can consider stage IB

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5
Q

stage 3 N0 disease

A

surgery, postop chemo if positive nodes in path

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6
Q

nonbulky N2 disease (one node 1-2cm)

A

neoadj chemorad–>surg

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7
Q

small cell treatment

A

limited stage: cis/carbo+etop+RT

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8
Q

mesothelioma treatment

A

if EPP–>chemo–>RT

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9
Q

platinum doublets superiority

A

all similar with median survivals of 8 months

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10
Q

second line therapy docetaxel

A

improved OS compared to BSC Shepard JCO 2000

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11
Q

pemetexed second line

A

Hanna- pemetrexed v. docetaxel, non-inferiority, better tolerated; limited to non-SCC

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12
Q

recurrent disease approved

A

doce, erlotinib, pemetrexed

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13
Q

two v. three drugs NSCLC

A

no clear advantage for third cytotoxic, or targeted to doublet

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14
Q

bevicizumab benefit

A

improved survival with carbo/taxol in non-squamous, E4599 Sandler NEJM 2006

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15
Q

bev with what backbone?

A

no OS benefit in combination with cis/gem (AVAIL trial), but still approved in variety of regimens. give with carbo/taxol

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16
Q

beva side effects

A

enhanced toxicity of standard cytotoxic- neuropathy, neutropenia, posterior leukoencephalopathy syndrome, tracheoesophageal fistula, HTN, thrombosis

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17
Q

bevacizumab contra

A

hemoptysis, anticoagulation, etc.

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18
Q

adenoca epi

A

least associated with tobacco, but most still tobacco associated

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19
Q

pem for SCC

A

cis/gem v. cis/pem for SCC–> non-SCC did better with pem

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20
Q

EGFR mutation epidemiology

A

Asians, never smokers, younger

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21
Q

ALK translocation

A

5% unselected Adeno, treat with crizotinib

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22
Q

ROS1 mutation

A

response to crizotinib

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23
Q

EGFR mutant

A

erlotinib or afatinib

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24
Q

erlotinib in non-EGFR mutant

A

FDA approved, might be a board answer in second-third line setting

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25
Q

maintenance tx

A

only for non-SCC, pemetrexed (switch or continuation); continuation maintenance is acceptable (E4599 data)

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26
Q

maintenance targeted therapy

A

erlotinib can be an option even in a non-selected patients

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27
Q

number of doses of doublet

A

only 4-6 cycles max, more not better with doublet, then thats all the benefit

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28
Q

ECOG 3-4 patients

A

do not benefit from cytotoxic therapy

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29
Q

elderly treatment

A

only based on PS, not chronologic age

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30
Q

locally advanced unresectable disease

A

RT AND chemo: concurrent if possible

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31
Q

chemoRT regimens

A

similar outcomes: cis/etop/RT v. carbo/taxol/RT–>carbo/taxol

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32
Q

for resected NSCLC, chemo

A

either neoadjuvant or adjuvant, predomin adjuvant

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33
Q

LACE trial

A

lung adjuvant cisplatin eval: meta-analysis: chemo decreases lung death by 6.9%

34
Q

PS2 patients adjuvant

A

better without chemo in adjuvant setting! in metastatic, give carbo-based instead of cis-based

35
Q

adjuvant benefit

A

more with stage III (NNT 8) ,stage II (NNT 10), stage IB (NNT 33)

36
Q

neoadjuvant chemotherapy

A

not predominant standard of care, boards questions based on adjuvant

37
Q

first line metastatic NSCLC

A

median survival 8 months for any doublet

38
Q

second line NSCLC

A

pemetrexed and docetaxel similar OS, pemetrexed better tolerated.

39
Q

bevacizumab for NSCLC

A

in NON-Squamous, PCB>PC had improved OS (2 month improvement). the benefit is only with carbo/taxol

40
Q

bevacizumab tox

A

bleeding ,clotting, HTN, proteinuria, dehiscence, increased neuropathy/neutropenia with chemo, tracheoesophageal fistula–>do not give with chemoradiotherapy, PLES (posterior leukoencephalopathy)

41
Q

anticoagulants and bev for NSCLC

A

generally avoided but not absolute contraindication

42
Q

SCC NSCLC and bev

A

no! pulmonary hemorrhage in 31% of pts treated (severe or fatal)

43
Q

cis/gem/bev for NSCLC

A

NO! bev didn’t improve outcome in this combination

44
Q

NSCLC SCC metastatic treatment versus non-SCC

A

squamous-gem; adeno-pem

45
Q

pemetrexed for NSCLC

A

only for non-squamous! (pem-adeno)

46
Q

erlotinib metastatic

A

acceptable treatment for wild type for boards

47
Q

ramicurimab

A

anti-VEGFR2 antibody that improved survival (1.4mo) in recurrent NSCLC with docetaxel (doce+ramicurimab v. doc)

48
Q

nivolumab for NSCLC

A

second line SCC approval compared to docetaxel–> OS 9.2 v 6mo

49
Q

how many cycles for first line NSCLC?

A

6 cycles max (4-6 okay) even if tolerating well. can consider maintenance

50
Q

PFS for NSCLC

A

if ECOG 3,4 , then no chemotherapy. ECOG 3: >50% in bed

51
Q

NSCLC lung genetics

A

Kras 25%, EGFR 17%, ALK 8%, HER2 3%, BRAF 2%, PI3K 1%, MET 1% RET 1%

52
Q

EGFR mutation

A

response rate high if mutant (gefitnib, erlotinib). activating mutations

53
Q

crizotinib indications

A

ALK mutant (but some benefit in ROS mutation even though not on FDA label)

54
Q

ceritinib for NSCLC

A

second generation ALK inhibitor, benefit even after crizotinib progression

55
Q

SCC mutations NSCLC

A

FGFR amp, PTEN mutation, PTEN los, PIK3CA mutation, DDR2 mutation

56
Q

switch or continuation maintenance therapy for NSCLC

A

benefit only for non-squamous- PFS to switching to pemetrexed after platinum doublet, can continue bevacizumab

57
Q

resistant EGFR mutations

A

T790M, D761Y

58
Q

unresectable NSCLC

A

chemoradiation (cis/etop/RT or carbo/taxol/RT)

59
Q

large cell neuroendocrine cancer

A

treat by default as an adenocarcinoma NSCLC, or you can treat based on what it looks like (could look like small cell)

60
Q

neoadjuvant therapy NSCLC

A

theoretical reason for benefit- better delivery of chemo prior to surgery, better tolerated, measure of response,

61
Q

erlotinib flare

A

can have growth of cancer with stopping. give erlotinib all the way up to chemo

62
Q

NSCLC Stage IB Dx and Tx

A

3-5cm. surgery, consider RT.

63
Q

Adjuvant NSCLC chemo

A

ONLY CIS-based (cis/vino or cis/etop)–> 5% abs benefit

64
Q

Stage IIIa non-bulky definition

A

no or small N2 (mediastin/carinal) clinically (one node)

65
Q

Stage IIIa non-bulky management

A

resectable–> give surgery–>adj chemo and RT, or chemorad–>surgery, or NA chemo–>surgy

66
Q

Stage IIIa bulky (cN2+) or IIIb

A

usually unresectable: Tx is chemoRT (cis/etop/RT best, or carbo/taxol/RT–>carbo/taxol)

67
Q

Pancoast tumor defn and tx

A

superior sulcus–> Horner syndrome - ptosis, miosis, and anhidrosis) + pain. Tx if N1 or less–> chemoRT–>surgery

68
Q

bev contraindications

A

cavitating tumor, SCC, hemoptysis, bleeding. relative: brain tumors (caution), anticoagulation (use caution)

69
Q

brain mets therapy for NSCLC

A

isolated cerebral met: resect+WBRT, or SRS+WBRT if

70
Q

alk fusion treatment

A

crizotinib, if progress, ceratinib

71
Q

ROS1 translocation

A

can treat with crizotinib

72
Q

BRAF in NSCLC

A

can respond to dabrafenib or +tremitinib

73
Q

RET mutation

A

can respond to cabozantinib

74
Q

MET abnl

A

can respond to crizotinib

75
Q

treatment if pneumonectomy required

A

chemoRT. pneumonectomy inferior survival

76
Q

PS2 chemotherapy

A

pem+carbo was better OS than pem alone. avoid cis

77
Q

low dose CT scanning criteria

A

30pk*yr AND age 55-70. One time deal.

78
Q

when is mediastinoscopy not needed

A

normal CT, normal PET

79
Q

RT for small tumors

A

can give 60Gy in 30 Fx if not adequate PFTs, or SRS if

80
Q

adjuvant chemo indications

A

stage IB consider, all with stage II-IIIA (if not chemoRT)

Thoracic COPY (3 decks)

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