4: Lung Cancer Epidemiology II Flashcards
Give examples of the 2 types of lung cancer treatment
Curative:
- Surgery
- Radical radiotherapy (eg stereotactic ablative, SABR)
- Radical chemoradiotherapy
Palliative:
- Radiotherapy
- Systemic anticancer therapy
- Combinations
What factors act as independent predictors of survival
Sex
Age
Stage
Performance status
What is performance status, how is it categorized?
Symptoms and function of ability of patient
0 = normal ability
1 = small restriction to daily abilities
2 = capable of self care >50% of time
3 = capable of self care <50% of time
4 = bedridden
What factors may contribute to why performance status has effect on the prediction of survival
A better PS means..
- better response to treatment
- more likely to be in receipt of treatment
What are the most important predictors of survival for lung cancer, how much % can it effect?
Stage (up to 458% more likely to die in highest stage)
Performance status (up to 439% more likely to die in worst PS)
How much % difference is there between male and females in prediction of survival
1 : 1.13
Males 13% more likely to die than female
Describe the variation in treatment across the regions in the UK for surgery, and why this is significant
There is a up to a 2 fold difference across the country in % patients receiving surgery for NSCLC (eg from SE coast -=> Thames)
This is important as surgery makes a big difference to number of patients cured
What is VATS, what benefit does it have over open/ traditional surgery
VATS: video assisted thoracic surgery
Impede results in complications, atelectasis (lung collapse), deaths.
What types of lung cancer are more radiosensitive ?
Squamous & small cell
Describe the types of radiotherapy with curative intent
- Stereoablative body RT (SABR): high dose, low number doses (concentrated). Doesn’t rely on hitting cells in metaphase.
55-65 Gy x3-7 - Conventional: 66 Gy over 6-7 weeks (USA)
- Continous Hyperfractionated Accelerated RT (CHART): lower radiation dose, slightly superior to conventional. 55 Gy, 3x daily for 14 days.
What areas of the lung are SABR versus Radical RTs directed at?
Radical RTs: larger, central cancers
SABR: peripheral, outside ‘no fly zone’
List complications that occur when SABR is given inside the ‘n fly zone’
Too close to blood vessels and air ways therefore:
- massive haemoptysis (coughing blood)
- pneumonia
- airway necrosis
- perciardial effusion (fluid accumulation)
Above what Gy is considered ‘ablative’
20 Gy
What is ‘ablative’
Destroyed, dead cells
What is radio frequency / microwave ablation, why is it no longer used?
- cathodes inserted into solid tumour region
- heats tumour to 60C
- allow to cool, cycles repeat to cause ablation
Not used anymore due to development of SABR technology
Under what circumstance is post-op radiotherapy often administered?
If resection margins are positive (cancer cells are found at the edge where surgery was performed)
When and why are these forms of pre- and post-operative chemo therapies used:
- induction
- neo-adjuvant
- adjuvant
- induction: prior to operation, aims to down-stage tumour with curative intent.
- neo-adjuvant: pre-operative, reduces chance of metastasis
- adjuvant: post-op to reduce chance of metastasis
What are the adjuvant TKIs after surgery for these pathways, and what clinical trials do they belong to:
- ALK
- MET
- KRAS G12
- ROS1, NTRK
- BRAF
- RET
ALNEO trial:
- ALK: alectinib
Geometry-N trial:
- MET: Capmatinib
NAUTIKA-1 trial:
- KRAS G12: Divarasib
- ROS1, NTRK: Entrectinib
- BRAF: Vemurafenib/ cobimetinib
- RET: Pralsetinib
What was the % increase of event-free survival for patients with neo-adjuvant immunotherapy (nivolumab & chemo) versus those with chemo alone?
13% increase at 12 months
18% increase at 24 months
What are some examples of treatment for lung cancer with palliative intent?
- Radiotherapy (symptom relief)
- SACT (chemoradiotherapy)
- Supportive & palliative care
- Endobronchial treatment
How can radiotherapy be used as palliative intent?
- symptom relief:
- treats haemoptysis or pain with a 60-70% response rate
What is prophylactic cranial irradiation (PCI) and when is it used?
Used to kill brain cancer cells that have metastasized, arising from small cell lung cancer.
It improves survival, but is associated with cognitive decline.
What mutation positive lung cancer does osimertinib show increased progression-free survival against?
EGFR T790
Which drug is more effective against ALK-EML4: crizotinib or alectinib
- alectinib has a lower cumulative incidence of CNS progression (metastasis to brain), 9.4% (compared to criztotinib 31.4%)
- crizotinib has a lower overall survival %
