E2 Lung cancer

Question 1

risk factors

Answer 1

all self explanatory dont worry about it

Question 2

6 gene/mutation things listed under etiology

Answer 2

EGFR mutations
KRAS mutations
ALK inhibition
ROS-1 mutations
BRAF
PD-L1 status
so basically fuckin all of em ig

Question 3

Patients with EGFR mutations, ALK or ROS-1 rearrangements typically (do/don’t) have PD-1 expression

Answer 3

don’t

Question 4

Most common in non-smokers
A. NSCLC
B. SCLC

Answer 4

A

Question 5

Fast growing and rapidly progressive
A. NSCLC
B. SCLC

Answer 5

B

Question 6

Most common histology of NSCLC
A. Adenocarcinoma
B. Squamous
C. Large Cell
D. Small cell

Answer 6

A

Question 7

Highy sensitive to radiation and chemo
A. NSCLC
B. SCLC

Answer 7

B

Question 8

Tumor is confined to hemithorax and contained in a radiation port
A. limited stage
B. extensive stage

Answer 8

A

Question 9

Tumor not confined to hemithorax of origin, not contained in a radiation port, distant metastasis

A. limited stage
B. extensive stage

Answer 9

B

Question 10

Curative intent
A. limited stage
B. extensive stage

Answer 10

A

Question 11

Limited stage disease:
Best results if radiation is given concurrently with _______

Answer 11

cisplatin

Question 12

T or F:
Surgery plays a large role in therapy for NSCLC

Answer 12

true

Question 13

T or F:
in limited stage, more than 50% of patients will develop brain metastases

Answer 13

true

Question 14

Regimens for limited stage:
Preferred regimen (named EP) *

Answer 14

Cisplatin
etoposide

Question 15

Extensive stage:
platinum based combo therapy (with/without) radiation is preferred

Answer 15

without, i wouldnt think that but ok

Question 16

extensive stage:
when should whole brain radiation be started prior to chemo

Answer 16

if pt is symptomatic

Question 17

first line immunotherapy for extensive stage *

Answer 17

Atezolizumab + Carboplatin + etoposide
ACE
OR
Durvalumab + carboplatin + etoposide

Question 18

when is pembro an option?

Answer 18

metastatic SCLC pts who have progressed after plat-based chemo and at least 1 prior line of therapy

Question 19

T or F:
Pembro is used regardless of PD-1 status

Answer 19

true

Question 20

what is the most efficacious modality for treatment of NSCLC

Answer 20

surgery

Question 21

NSCLC: (low/moderately) sensitive to radiation and (low/moderately) sensitivity to chemo

Answer 21

moderately
low

Question 22

NSCLC -> Resectable -> neoadjuvant -> surgery -> ?

Answer 22

chemo followed by immunotherapy or oral agent

Question 23

neoadjuvant therapy:
__________ + a platinum doublet should be considered in those with tumors > __ or node positive

Answer 23

Nivolumab, 4

Question 24

what is considered the standard of care for NSCLC?

Answer 24

adjuvant chemo

Question 25

Preferred (non-squamous_ adjuvant therapy option

Answer 25

Cisplatin + Pemetrexed
(both IV)

Question 26

Preferred (squamous)

Answer 26

Cisplatin + gemcitabine/docotaxel

Question 27

NSCLC -> Unresectable -> ? and ?

Answer 27

chemo and radiation *

Question 28

what to do in unresectable stage IIIB or IV

Answer 28

chemo + radiation

Question 29

Stage III Unresectable Immunotherapy:
Now an option for pts who are not candidates for surgery or definitive chemo with radiation

Answer 29

Pembro, PD-L1 >1%

Question 30

Stage IIIB and IV disease:
no optimal regimen yet but they tested these 4, which had fewest toxicities?
A. Cisplatin/paclitaxel
B. Cisplatin/gemcitabine
C. Cisplatin/docetaxel
D. Carboplatin/paclitaxel

Answer 30

D

Question 31

NSCLC advanced metastatic -> chemo + ________

Answer 31

targeted therapy

Question 32

If a patient has a targetable mutation and is PD-L1 (+), it is preferred to use the _____ therapies first and then move to _________ later

Answer 32

oral
immunotherapy

Question 33

exon 19 and 21 drug and any other shit you can think of

Answer 33

Osimertinib
T790M
EGFR targeting

Question 34

T or F:
Osimertinib can cause QTC prolongation

Answer 34

true

Question 35

dabraf cyp

Answer 35

3a4

Question 36

dabraf underlined toxicities (2)

Answer 36

fevers, secondary skin cancers

Question 37

Trametinib underlined toxicities (4)

Answer 37

fever
rash
visual changes
retinal detachment

Question 38

which mutation is associated with smoking cigs?
A. ALK
B. EGFR
C. KRAS
D. PD-L

Answer 38

C. KRAS

Question 39

PD-L1 positive of above >__% allows the use of pembro

Answer 39

1

Question 40

treatment of metastatic NON-squamous:
Use of oral chemo
A. mutation negative
B. mutation positive

Answer 40

B

Question 41

1st line NON-squamous

Answer 41

carboplatin+pemetrexed + pembro

Question 42

treatment of metastatic squamous:
if no contraindication to immunotherapy

Answer 42

pembro or
pembro +chemo
or
atezolizumab or nivolumab or cemipilmab-rwlc

Question 43

Treatment metastatic squamous:
if contraindication to immunotherapy

Answer 43

platinum doublet

Question 44

in 1st line squamous carboplat is typically combined with what

Answer 44

gemcitabine or any of the -taxels

Question 45

okay so after all of that shit theres a slide that says “new standard” for squamous NSCLC, what are the 3 drugs?

Answer 45

carboplat + pembro + paclitaxel