NSCLC

Question 1

Second line for NSCLC

Answer 1

docetaxel +/- ramucirumab

Question 2

First line for BRAF mutant NSCLC

Answer 2

BRAF/MEK

Question 3

First line for RET mutant NSCLC

Answer 3

RET inhibitors - Selpercatinib (Libretto 431) + pralsetinib

Question 4

First line for MET mutant NSCLC

Answer 4

MET inhibitors - capmatinib vs. tepotinib

Question 5

Osimertinib SE’s

Answer 5

cardiomyopathy
long QT syndrome

Question 6

amivantimab targets?

Answer 6

EGFR + MET

Question 7

First line ALK targeted therapies

Answer 7

alectinib
brigatinib
Lorlatinib
*Ceritinib (not preferred but also category 1)
*crizotinib (not preferred but also category 1)

Question 8

Class effect ALK inhibitor SE’s to know

Answer 8

bradycardia
pneumonitis

Question 9

Drugs targeted ROS1

Answer 9

Crizotinib
entrectinib
repotrectinib

Question 10

crizotinib SE’s to know

Answer 10

• visual dysfunction
• hepatotoxicity
• low testosterone

Question 11

RET fusion targeting drugs

Answer 11

selpercatinib
pralsetinib

Question 12

Drugs targeting MET

Answer 12

tepotinib
capmatinib
Amivantimab

Question 13

Class effect of MET inhibitors to know

Answer 13

• peripheral edema

Question 14

NTRK targeting drugs

Answer 14

entrectinib
lorlectinib

Question 15

KRAS g12c targeting drugs

Answer 15

Sotorasib
Adagrasib

Question 16

First line for KRAS

Answer 16

Chemoimmunotherapy

Question 17

Line of therapy for which HER2 is approved in NSCLC

Answer 17

second line or subsequent

Question 18

Stains for adeno

Answer 18

***CK7
Napsin A
TTF1

Question 19

CK20 positive suggests what tissue origin

Answer 19

GI tract primary

Question 20

T3 NSCLC

Answer 20

1)Tumor >5 cm but ≤7 cm in greatest dimension
2)or associated with separate tumor nodule(s) in the same lobe as the primary tumor
3) or directly invades any of the following structures: chest wall (including the parietal pleura and superior sulcus tumors), phrenic nerve, parietal pericardium

Question 21

T2 NSCLC

Answer 21

1)Tumor >3 cm but ≤5 cm
2)or tumor with any of the following features:Δ
Involves main bronchus regardless of distance from the carina but without involvement of the carina
Invades visceral pleura
3)Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, involving part or all of the lung

Question 22

T staging that indicates adjuvant chemo

Answer 22

Greater than 4 cm is T2b

Question 23

N3 disease

Answer 23

Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

Question 24

N2 disease

Answer 24

Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)

Question 25

N1 disease

Answer 25

Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension

Question 26

IA vs. IB

Answer 26

T2 qualifies as IB *Important since changes management

Question 27

Adjuvant immunotherapy indication

Answer 27

- atezo if PD-L1 positive - pembro regardless (approval, but benefit unknown)

Question 28

ALK drug studied in Alina for adjuvant of ALK mutant NSCLC

Answer 28

Alectinib

Question 29

Necessary FEV1 post-op for determining surgical candidacy

Answer 29

1.5L for lobectomy Greater than 2L for pneumonectomy *board question may state this and answer will be radiation over surgery

Question 30

Management of unresectable superior sulcus tumor

Answer 30

Chemoradiation followed by adjuvant durvalumab

Question 31

typical first line regimen for squamous and nonsquamous

Answer 31

adeno - carbo/pem/pem squam - carbo/taxol/pembro

Question 32

adeno stains

Answer 32

CK7 TTF1

Question 33

squam stains

Answer 33

P63 P40 TTF1 negative *impt to know since may just give stains

Question 34

Concurrent chemoradiation regimens for 1) nonsquamous 2) squamous

Answer 34

Nonsquamous: - carbo/pem - cis/pem - carbo/taxol Squamous: - carbo/taxol - cisplatin/etoposide

Question 35

Nonresectable superior sulcus tumor management

Answer 35

Definitive CRT followed by durvalumab

Question 36

Board answer to patient to CR to pembro and NED at 2 years

Answer 36

Stop treatment

Question 37

Management of oligometastatic NSCLC with PR

Answer 37

Local therapy (XRT) to sites of residual disease

Question 38

Indication for adjuvant immunotherapy

Answer 38

- same as for chemo (tumors of 4 cm or larger)

Question 39

Indication for adjuvant atezo

Answer 39

- Stage II-IIIA - PDL1 greater than 1%

Question 40

Answer to adjuvant for visceral pleural invasion on boards

Answer 40

If multiple high risk features (poorly differentiated, vascular invasion, wedge resection, visceral pleural invasion, unknown nodal status), give adjuvant cehmo

Question 41

Approved line of therapy for KRAS targeted therapy

Answer 41

Second line

Question 42

Second line for small cell

Answer 42

*REMEMBER, depends on platinum sensitivity (relapse after 3-6 months considered platinum sensitive)

Question 43

Line of therapy for RET in solid tumor

Answer 43

- second line or later for any solid tumor (tissue agnostic)

Question 44

Line of therapy for RET targeted therapy

Answer 44

Firstline

Question 45

Indication for lung cancer screening

Answer 45

- age 50-85 - 20 pack-year smoking history - currently smoke or have quit within 15 years

Question 46

Standard radiation dose for NSCLC CRT

Answer 46

60 Gy

Question 47

EGFR exon 20 drugs approved for second line

Answer 47

*Mobicertinib Amivantamab

Question 48

Management of localized sarcomatoid mesothelioma

Answer 48

Ipi/nivo *No surgical cytoreduction (aggressive disease biology)

Question 49

Characteristics of malignant pleural effusion per Light certiera

Answer 49

- pleural fluid protein to serum protein ratio >0.5 - pleural fluid LDH to serum LDH >0.6 - OR pleural fluid LDH > 2/3's of ULN of serum LDH *rapid recurrence

Question 50

CrCl threshold for pemetrexed

Answer 50

CrCl>45

Question 51

Staging of thymoma

Answer 51

Stage 1 - completely encapsulated Stage 2 - transcapsular invasion and/or extension to surrounding tissue Stage 3 - Extension to neighboring organ Stage 4 - pleural, pericardial, lymphogenous, hematogenous dissemination

Question 52

First line for metastatic thymoma

Answer 52

cisplatin, doxorubin, cyclophosphamide, and prednisone for 6 cycles

Question 53

Management of grade 1 mucositis per boards

Answer 53

"sodium bicarbonate mouthwash with local anesthetics and antiulcer medication"

Question 54

First line options for epitheliod mesothelioma

Answer 54

- nivo/ipi - platinum/pemetrexed +/- bev

Question 55

Most common SE of selpercatinib + second most common

Answer 55

1) HTN most commonly 2) Elevated liver enzymes

Question 56

CNS activity of ROS1 TKI's

Answer 56

- entrectinib and repotrectinib have good CNS activity

Question 57

Line of therapy for ROS1 TKI's

Answer 57

First line

Question 58

First line for thymic carcinoma

Answer 58

carbo/taxol

Question 59

Stage IIIB requires

Answer 59

T3-4 N2 OR N3 disease

Question 60

Second line for thymoma

Answer 60

Pemetrexed

Question 61

How is cervical adenopathy staged in NSCLC?

Answer 61

M1

Question 62

Other high emetic risk drugs

Answer 62

- ACT - carbo AUC >4 - cytoxan >1500 - dacarbazine - TDxd - ifosfamide - melphalaen - sacituzumab