Treatment of Lung Cancer

Question 1

In general terms, how do you treat stage 1-2 NSCLC?

Answer 1

Surgical resection

Question 2

What is the category for NSCLC to merit further treatment, other than resection? What is the treatment?

Answer 2

Stage 3-4

Resected surgically but surrounding lymph nodes are +

> 4cm width

Treat with Adjuvant 2-agent chemo consisting of one platinum-based agent + another chemo drug.

MUST HAVE A PLATINUM BASED AGENT

Question 3

How do you treat metastatic SCLC?

Answer 3

Radiation is the only option.

Question 4

How do you treat both SCLC and NSCLC if they are confined to the chest and mediastinal lymph nodes?

Answer 4

Combined chemo/radiation

Question 5

Tx for adenocarcinoma with an EGFR mutation.

Answer 5

Erlotinib

Question 6

Tx for adenocarcinoma with an ALK translocation.

Answer 6

Crizotinib

Question 7

How do you treat inoperable adenocarcinoma?

Answer 7

Double agent chemotherapy with 
1. Cisplatin or Carboplatin
\+ one of the following:
a. Paclitaxel
b. Etoposide
c. Pemetrexed

+/- Bevacizumab

Question 8

For Adenocarcinoma, when is Bevacizumab shown to be helpful?

Answer 8

Only when combined with Carboplatin and Paclitaxel.

Question 9

MOA of Paclitaxel,

Answer 9

Paclitaxel and Docitaxel are TAXANES! Mitotic spindle inhibitors. Prevent microtubules from de-polymerizing. THey stabilize the microtubule structure.

Question 10

Worst toxicity of Taxanes. (Also with Vinca alkaloids)

Answer 10

Peripheral Neuropathy - tingling of the extremities.

Question 11

Pemetrexed works by what MOA?

Answer 11

It’s a thymidylate synthase inhibitor. Prevents purine and pyrimidine synthesis, therefore blocks the synthesis of DNA/RNA.

Question 12

Etoposide works by what mechanism?

Answer 12

Etoposide/Toniposide are Topoisomerase inhibitors. Prevent repair after strand breakage.

Question 13

How does Bevacizumab work?

Answer 13

It’s a VEGF inhibitor, preventing the proliferation of vascular epithelium. Starves the tumor of its nutrient supply.

Question 14

In which cancer is Bevacizumab contraindicated?

Answer 14

Squamous cell carcinoma! It causes hemorrhages, some fatal.

Question 15

What is the treatment for an unoperable case of squamous cell carcinoma? (2 drug regimen)

Answer 15

Cisplatin/Carboplatin +

a. Paclitaxel
b. Etoposide
c. Vinorelbine

Question 16

What is the MOA of vinorelbine?

Answer 16

Vinorelbine is a vinca alkaloid! They are inhibitors of microtubule polymerization.

Question 17

How do you treat Small Cell Carcinoma?

Answer 17

Radiation.

You can try combo chemo with a Platin plus a topoisomerase inhibitor: Etoposide or Irinotecan/Topotecan.

Question 18

Can you cure small cell carcinoma?

Answer 18

Some cases have been cured. These were isolated only within the chest cavity and cured with focal radiation.