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Thera IX > 14 Lung Cancer Lee > Flashcards

14 Lung Cancer Lee Flashcards

1
Q

What are some Genetic Changes that increase the risk of lung cancer?

A

Mutation tumor suppressor (p53). BCL-2, EGFR overexpression. K-RAS gene mutation. ALK (anaplastic lymphoma kinase) mutation

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2
Q

What is prevention and early detection like for lung cancer?

A

Low-dose CT scan-based screening (detected LC at earlier stages, recommended in high-risk (age > 55, former smokers). No established chemoprevention agents yet. NO tumor marker to detect lung CA at early stages

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3
Q

What is Small Cell Lung Cancer (SCLC)?

A

Oat cell, strongly linking to SMOKING. Most aggressive natural course. Only 14% of lung cancers

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4
Q

What is Non-Small Cell Lung Cancer (NSCLC)?

A

Adenocarcinoma (incidence rising, most common in non-smokers). Squamous cell (clearly related to smoking). Large cell

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5
Q

What are the characteristics of SCLC?

A

Rapid doubling time. High rate of metastases. Treatment: highly sensitive to radiation and chemotherapy. High rate of paraneoplastic syndrome (PNS)

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6
Q

What are the characteristics of NSCLC?

A

Relatively slow growing. Low rate of metastases. Treatment: surgery in Stage I and II; less sensitive to chemotherapy than SCLC. Low rate of PNS

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7
Q

What is Paraneoplastic Syndrome?

A

Due to tumor secretion of hormone like substances): Weight loss, Cushing’s syndrome (ACTH), Anemia, Hyponatremia (SIADH), Hypercalcemia (PTH), Clubbing

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8
Q

What are the SCLC stages?

A

Limited disease. Extensive disease

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9
Q

What is Limited disease SCLC?

A

Tumor confined to hemithorax of origin and/or the mediastinum and supraclavicular nodes. Fits in a radiation field

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10
Q

What is Extensive disease SCLC?

A

Tumor not confined to hemithorax of origin. Distant metastasis

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11
Q

What are the treatment options for SCLC?

A

Single or combo modality. Surgery rarely, only in very early stage (if confined to chest w/o nodal invasion). Radiation: very radiosensitive

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12
Q

What is radiation therapy like in SCLC?

A

Goal = cure in limited disease (concurrent chemotx + radiation). Palliative role in extensive disease (bone pain, symptomatic brain mets, SVC syndrome). PCI (prophylactic cranial irradiation): Eradication of occult, microscopic brain metastasis

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13
Q

What are the combination chemotx choices for SCLC (all stages)?

A

EP (Etoposide, Cisplatin). EP + Radiation in limited disease. EC (Etoposide + Carboplatin). Cisplatin + Irinotecan

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14
Q

What are the complications of treatment with RT + CT (Etoposide/Cisplatin)?

A

Mucositis, Esophagitis, Esophageal stricture. Myelosuppression. Skin reactions. N/V, wight loss. Renal dysfunction

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15
Q

What is second line or salvage therapy for SCLC?

A

Most SCLC will relapse: median survival = only 4-5 months when treated w/ further chemotherapy. Second line chemotx provides palliation

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16
Q

What are the agents used in second line or salvage therapy for SCLC?

A

Docetaxel. Gemcitabine. Ifosfamide. Irinotecan. Paclitaxel. Topotecan. Temozolamide (if w/ brain mets). Vinorelbine

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17
Q

What is the prognosis and treatment tightly linked to for NSCLC?

A

Stage and well as patient factors (PS, histology, biomarker, gender, weight loss)

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18
Q

What is Stage I NSCLC?

A

Tumor of any size, located to lung, no lymph nodes

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19
Q

What is Stage II NSCLC?

A

Same as stage I, but WITH lymph node involvement

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20
Q

What is Stage IIIa NSCLC?

A

Tumor in chest wall, main bronchus or mediastinum

21
Q

What is Stage IIIb NSCLC?

A

Tumor extending into mediastinal structure

22
Q

Which stages of NSCLC are unresectable and have the lowest survival?

A

Stage IIIb, Stage IV

23
Q

What are the treatment options for Resectable Stages of NSCLC (I, II, IIIa)?

A

Surgery is tx of choice w/ curative intent. Radiation (Stage I and II): treatment for medically inoperable, positive margins after surgery). Chemotherapy: adjuvant cisplatin-based (II, IIIa)

24
Q

What is the treatment option for Stage IIIa (N2) - locally advanced, resectable NSCLC?

A

Standard: combined modality (3). Surgery –> adjuvant CT +/- RT. OR. Induction chemoradiation –> surgery

25
Q

What is the treatment option for UNresectable Stage IIIa/IIIb NSCLC?

A

Associated w/ high rate of occult metastases; systemic relapse ~70%. Combined chemoradiation - concurrent better than sequential

26
Q

What is treatment like for Advanced or Metastatic disease NSCLC?

A

Systemic chemotx: NSCLC only moderately sensitive. Benefit: good PS (performance status: 0-2), >70% Karnofsky, <10% weight loss. PS 3-4: no benefit from tx. Chemotx alone as palliation for Stage IIIb, IV

27
Q

What type of NSCLC requires mutation testing?

A

Adenocarcinoma or Large cell. Not routinely recommended for Squamous NSCLC

28
Q

What treatment options are there for a patient if EGFR or ALK negative?

A

Chemotherapy

29
Q

What treatment options are there for a patient if EGFR positive?

A

Erlotinib

30
Q

What treatment options are there for a patient if ALK positive?

A

Crizotinib

31
Q

What would you choose for firstline therapy if: Stage IV, heavy former smoker, Adenocarcinoma, female, EGFR mutation is negative?

A

Systemic chemotx. Carbo/Paclitaxel, Carb/Pem, Carbo/Gem, Cis/Pem. In absence of squamous histology, brain mets, or hemoptysis –> Bevacizumab + Chemo (Carb/Paclitaxel/BV)

32
Q

What does a Zubrod Scale of 0 or Karnofsky Scale of 90-100% indicated?

A

Normal

33
Q

What does a Zubrod Scale of 1 or Karnofsky Scale of 70-80% indicated

A

Symptomatic without significant decrease in daily activities

34
Q

What does a Zubrod Scale of 2 or Karnofsky Scale of 50-60% indicated

A

In bed or chair less than 50% of waking hours

35
Q

What does a Zubrod Scale of 3 or Karnofsky Scale of 30-40% indicated

A

In bed or chain more than 50% of waking hours

36
Q

What does a Zubrod Scale of 4 or Karnofsky Scale of 10-20% indicated

A

Bedridden (unable to care for self)

37
Q

What is standard first-line therapy for advanced NSCLC w/ good PS?

A

Platinum-based doublets. Cisplatin or Carboplatin PLUS: Paclitaxel, Docetaxel, Gemcitabine, Vinorelbine, Pemetrexed

38
Q

What does EGFR overexpression indicated?

A

Resistance to therapy, metastatic potential, and poorer Px. 17% of lung cancer. More frequently in women, never smoked, and adenocarcinomas (50% of Asian patients)

39
Q

What is treatment like for Non-Squamous histology, no hemoptysis?

A

Carboplatin/Paclitaxel + Bevacizumab

40
Q

What is treatment like for EGFR-expressing?

A

EGFR TKI (Erlotinib) or Gefitinib. OR. Cisplatin/Vinorelbine + Cetuximab

41
Q

What is the overall survival like for Cetuximab +/- Chemotherapy?

A

Based on acne-like rash. Development during 1st cycle = clinical biomarker predictive of overall survival benefit. Category 2B recommendation

42
Q

What are the toxicities with Cetuximab +/- Chemotherapy?

A

Neutropenia (40% grade 4), acne-like rash, infusion reactions, poor tolerance

43
Q

What are good predictors of response with Erlotinib?

A

Female. Adenocarcinoma. Non-smoker. Asian. EGFR (+). KRAS (-)

44
Q

What is maintenance therapy like in advanced NSCLC?

A

Delivered following 4-6 cycles of chemotx in patients who respond or have stable disease

45
Q

What are the second and third line therapy options if NSCLC progressed during/after platinum?

A

Single agent Docetaxel, Pemetrexed, or Erlotinib

46
Q

What is the treatment summary for Stage IV lung cancer?

A

Platinum-based combo of 2 drugs for PS 0-1. Single cytotoxic drug for PS 2. Halt chemotx if no response, if dz progresses, or 6 cycles given. Squamous: Pemetrexed less effective. Bevacizumab with Carbo-Paclitaxel

47
Q

What is first line treatment for Stage IV lung cancer that is ALK positive?

A

Crizotinib

48
Q

What is Malignant Pleural Effusion?

A

Accumulation of fluid in the pleural space. MOA: Impairment of lymphatic drainage from pleural space d/t tumor obstruction

49
Q

What is the treatment for Malignant Pleural Effusion?

A

Thoracentesis: chest drainage for fluid evacuation. Pleurodesis: instill sclerosing agent (Talc slurry > 90% effective)

Thera IX (29 decks)

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