31_32_Lung cancer therapy Flashcards
What are the three types of lung cancer therapy based on the aim?
Curative, Palliative, and Supportive.
What is ECOG in lung cancer therapy?
An evaluation of how fit the patient is to undergo chemotherapy, immunotherapy, or surgery -> the patient must be fit enough to survive the procedure.
What are the therapy possibilities for lung cancer?
- Surgery,
- chemotherapy,
- immunotherapy,
- targeted therapy
- radiation therapy.
What are the first line therapy options for SCLC stages I-III?
- 6 cycles of cisplatin/carboplatin + etoposide chemotherapy
- radiation of the chest after the 3rd cycle.
What is the first line therapy option for SCLC stage IV?
4-6 cycles of cisplatin/carboplatin + etoposide chemotherapy.
What are the second line therapy options for SCLC?
- Topotecan
- Epirubicin-cyclophosphamide-vincristine (4 cycles).
Is SCLC sensitive to chemotherapy?
Yes, but it always returns.
What is the recommended treatment for NSCLC in stages IA-IIIA?
Surgery
What is neoadjuvant chemotherapy?
Chemotherapy given before surgery to ease resectability.
What is adjuvant chemotherapy?
Chemotherapy given after surgery, typically from stage IB.
What is the recommended treatment for NSCLC in stages IIIB-IV?
Palliative chemotherapy, including targeted and immune therapy.
What is the first-line chemotherapy treatment for NSCLC?
Cisplatin/carboplatin + gemcitabine.
gem(jem) citabine (citadine) - (jem est une citadine)
What are the possible side effects of chemotherapy?
- Myelosuppression (neutropenia, anemia, thrombocytopenia),
- mucositis of the digestive tract,
- nausea, vomiting,
- alopecia,
- fatigue,
- neuropathy,
- renal impairment.
What is targeted therapy in adenocarcinomas?
Examination of mutations in adenocarcinomas to determine the appropriate targeted therapy.
What is the function of EGFR inhibitors?
To inhibit the tyrosine kinase function of the tyrosine kinase domain of the receptors.
What are the three generations of EGFR inhibitors?
- First generation - gefitinib, erlotinib;
- Second generation - afatinib;
- Third generation - osimertinib.
What are the side effects of EGFR inhibitors?
Skin issues, rash, constipation, nausea.
What is the function of anti-VEGF drugs?
To inhibit VEGF, which decreases O2 and nutrients to the tumor, leading to necrosis.
What is the contraindication for bevacizumab?
Diseases of vessels.
What are the side effects of bevacizumab?
Bleeding, hemoptysis, hypertension.
What is KRAS?
A molecule with GTPase activity, the downstream element of pathways starting with EGFR and MET receptors.
What happens if mutation is present in KRAS?
It causes EGFR TKI drug resistance and has a bad prognosis.
What is sotorasib?
A drug used as a target therapy for KRAS.
What is BRAF?
A protooncogene, a serine-threonine kinase.
What happens if there is a mutation in BRAF?
It leads to the constant activation of RAS/RAF/MEK/ERK pathway, causing proliferation.
What is the combination therapy used for BRAF mutation?
Trametinib (MEK inhibitor) and dabrafenib (RAF inhibitor).
What is ALK positive lung cancer?
A category of NSCLC caused by a mutation in anaplastic lymphoma kinase gene.
What are the three generations of drugs used for ALK positive lung cancer?
First generation - crizotinib; Second generation - alectinib, brigatinib; Third generation - lorlatinib.
crizo(trizo) + alec bridgerton (alec briga)
What is PD-L1?
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.
What is the treatment for inhibiting the connection between PD-L1 and PD-1?
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.
What types of cancer can be treated with immunotherapy?
Not only adenocarcinoma, but also squamous cell carcinoma can be treated with immunotherapy.
Who are the ideal candidates for immunotherapy?
Patients with smoking in their anamnesis react better to immunotherapy due to more mutations and a more immunogenic tumor.
What are the side effects of immunotherapy?
Autoimmune reactions, such as thyroiditis and hypophysitis, due to increased T-cell activity.
What is the relative contraindication for immunotherapy?
Patients who have autoimmune disease or take immunosuppressants are relatively contraindicated for immunotherapy.
What is radiation therapy?
The delivery of focused high-energy X-rays to affect rapidly dividing cells, such as cancer cells.
What is external irradiation?
A type of radiation therapy that irradiates a greater volume of tumor and normal tissue, but is easier to perform.
What is endoluminal brachytherapy?
A type of radiation therapy that delivers a higher radiation dose to the tumor and decreases the dose to normal tissues.
What are the possible side effects of radiation therapy?
Fatigue, hair loss in the area of the chest wall included in the radiation field, skin irritation, esophagitis, radiation pneumonitis or fibrosis.
What are the indications for palliative radiotherapy?
Primary lung tumor, SVC syndrome, brain metastases, spinal cord compression, and bone metastasis.
What is the treatment for SVC syndrome?
Radiation therapy for 1 to 2 weeks to achieve relief of symptoms, along with steroids and furosemide, and vena cava stent implantation if necessary.
What is the treatment for spinal cord compression?
Steroids and furosemide, surgery and/or radiotherapy depending on prognostic factors and patient life expectancy.
What is the treatment for bone metastasis?
Radiation therapy and/or surgery depending on the location and extent of the metastasis.
