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2. Pulmonology > 31_32_Lung cancer therapy > Flashcards

31_32_Lung cancer therapy Flashcards

1
Q

What are the three types of lung cancer therapy based on the aim?

A

Curative, Palliative, and Supportive.

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2
Q

What is ECOG in lung cancer therapy?

A

An evaluation of how fit the patient is to undergo chemotherapy, immunotherapy, or surgery -> the patient must be fit enough to survive the procedure.

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3
Q

What are the therapy possibilities for lung cancer?

A
  • Surgery,
  • chemotherapy,
  • immunotherapy,
  • targeted therapy
  • radiation therapy.
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4
Q

What are the first line therapy options for SCLC stages I-III?

A
  • 6 cycles of cisplatin/carboplatin + etoposide chemotherapy
  • radiation of the chest after the 3rd cycle.
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5
Q

What is the first line therapy option for SCLC stage IV?

A

4-6 cycles of cisplatin/carboplatin + etoposide chemotherapy.

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6
Q

What are the second line therapy options for SCLC?

A
  • Topotecan
  • Epirubicin-cyclophosphamide-vincristine (4 cycles).
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7
Q

Is SCLC sensitive to chemotherapy?

A

Yes, but it always returns.

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8
Q

What is the recommended treatment for NSCLC in stages IA-IIIA?

A

Surgery

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9
Q

What is neoadjuvant chemotherapy?

A

Chemotherapy given before surgery to ease resectability.

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10
Q

What is adjuvant chemotherapy?

A

Chemotherapy given after surgery, typically from stage IB.

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11
Q

What is the recommended treatment for NSCLC in stages IIIB-IV?

A

Palliative chemotherapy, including targeted and immune therapy.

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12
Q

What is the first-line chemotherapy treatment for NSCLC?

A

Cisplatin/carboplatin + gemcitabine.

gem(jem) citabine (citadine) - (jem est une citadine)

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13
Q

What are the possible side effects of chemotherapy?

A
  • Myelosuppression (neutropenia, anemia, thrombocytopenia),
  • mucositis of the digestive tract,
  • nausea, vomiting,
  • alopecia,
  • fatigue,
  • neuropathy,
  • renal impairment.
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14
Q

What is targeted therapy in adenocarcinomas?

A

Examination of mutations in adenocarcinomas to determine the appropriate targeted therapy.

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15
Q

What is the function of EGFR inhibitors?

A

To inhibit the tyrosine kinase function of the tyrosine kinase domain of the receptors.

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16
Q

What are the three generations of EGFR inhibitors?

A
  • First generation - gefitinib, erlotinib;
  • Second generation - afatinib;
  • Third generation - osimertinib.
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17
Q

What are the side effects of EGFR inhibitors?

A

Skin issues, rash, constipation, nausea.

18
Q

What is the function of anti-VEGF drugs?

A

To inhibit VEGF, which decreases O2 and nutrients to the tumor, leading to necrosis.

19
Q

What is the contraindication for bevacizumab?

A

Diseases of vessels.

20
Q

What are the side effects of bevacizumab?

A

Bleeding, hemoptysis, hypertension.

21
Q

What is KRAS?

A

A molecule with GTPase activity, the downstream element of pathways starting with EGFR and MET receptors.

22
Q

What happens if mutation is present in KRAS?

A

It causes EGFR TKI drug resistance and has a bad prognosis.

23
Q

What is sotorasib?

A

A drug used as a target therapy for KRAS.

24
Q

What is BRAF?

A

A protooncogene, a serine-threonine kinase.

25
Q

What happens if there is a mutation in BRAF?

A

It leads to the constant activation of RAS/RAF/MEK/ERK pathway, causing proliferation.

26
Q

What is the combination therapy used for BRAF mutation?

A

Trametinib (MEK inhibitor) and dabrafenib (RAF inhibitor).

27
Q

What is ALK positive lung cancer?

A

A category of NSCLC caused by a mutation in anaplastic lymphoma kinase gene.

28
Q

What are the three generations of drugs used for ALK positive lung cancer?

A

First generation - crizotinib; Second generation - alectinib, brigatinib; Third generation - lorlatinib.

crizo(trizo) + alec bridgerton (alec briga)

29
Q

What is PD-L1?

A

PD-L1 is a molecule secreted by tumor cells that binds to the PD-1 receptors of T-lymphocytes, inhibiting the anti-tumor activity of CD8+ cytotoxic T-cells.

30
Q

What is the treatment for inhibiting the connection between PD-L1 and PD-1?

A

Immune checkpoint inhibitor drugs, such as anti-PD-1 antibodies (nivolumab, pembrolizumab), anti-PD-L1 antibodies (atezolizumab, durvalumab), and CTLA-4 inhibitors can enhance the response of the immune system against the tumor.

31
Q

What types of cancer can be treated with immunotherapy?

A

Not only adenocarcinoma, but also squamous cell carcinoma can be treated with immunotherapy.

32
Q

Who are the ideal candidates for immunotherapy?

A

Patients with smoking in their anamnesis react better to immunotherapy due to more mutations and a more immunogenic tumor.

33
Q

What are the side effects of immunotherapy?

A

Autoimmune reactions, such as thyroiditis and hypophysitis, due to increased T-cell activity.

34
Q

What is the relative contraindication for immunotherapy?

A

Patients who have autoimmune disease or take immunosuppressants are relatively contraindicated for immunotherapy.

35
Q

What is radiation therapy?

A

The delivery of focused high-energy X-rays to affect rapidly dividing cells, such as cancer cells.

36
Q

What is external irradiation?

A

A type of radiation therapy that irradiates a greater volume of tumor and normal tissue, but is easier to perform.

37
Q

What is endoluminal brachytherapy?

A

A type of radiation therapy that delivers a higher radiation dose to the tumor and decreases the dose to normal tissues.

38
Q

What are the possible side effects of radiation therapy?

A

Fatigue, hair loss in the area of the chest wall included in the radiation field, skin irritation, esophagitis, radiation pneumonitis or fibrosis.

39
Q

What are the indications for palliative radiotherapy?

A

Primary lung tumor, SVC syndrome, brain metastases, spinal cord compression, and bone metastasis.

40
Q

What is the treatment for SVC syndrome?

A

Radiation therapy for 1 to 2 weeks to achieve relief of symptoms, along with steroids and furosemide, and vena cava stent implantation if necessary.

41
Q

What is the treatment for spinal cord compression?

A

Steroids and furosemide, surgery and/or radiotherapy depending on prognostic factors and patient life expectancy.

42
Q

What is the treatment for bone metastasis?

A

Radiation therapy and/or surgery depending on the location and extent of the metastasis.

2. Pulmonology (22 decks)

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