E2 Lung cancer Flashcards
risk factors
all self explanatory dont worry about it
6 gene/mutation things listed under etiology
EGFR mutations
KRAS mutations
ALK inhibition
ROS-1 mutations
BRAF
PD-L1 status
so basically fuckin all of em ig
Patients with EGFR mutations, ALK or ROS-1 rearrangements typically (do/don’t) have PD-1 expression
don’t
Most common in non-smokers
A. NSCLC
B. SCLC
A
Fast growing and rapidly progressive
A. NSCLC
B. SCLC
B
Most common histology of NSCLC
A. Adenocarcinoma
B. Squamous
C. Large Cell
D. Small cell
A
Highy sensitive to radiation and chemo
A. NSCLC
B. SCLC
B
Tumor is confined to hemithorax and contained in a radiation port
A. limited stage
B. extensive stage
A
Tumor not confined to hemithorax of origin, not contained in a radiation port, distant metastasis
A. limited stage
B. extensive stage
B
Curative intent
A. limited stage
B. extensive stage
A
Limited stage disease:
Best results if radiation is given concurrently with _______
cisplatin
T or F:
Surgery plays a large role in therapy for NSCLC
true
T or F:
in limited stage, more than 50% of patients will develop brain metastases
true
Regimens for limited stage:
Preferred regimen (named EP) *
Cisplatin
etoposide
Extensive stage:
platinum based combo therapy (with/without) radiation is preferred
without, i wouldnt think that but ok
extensive stage:
when should whole brain radiation be started prior to chemo
if pt is symptomatic
first line immunotherapy for extensive stage *
Atezolizumab + Carboplatin + etoposide
ACE
OR
Durvalumab + carboplatin + etoposide
when is pembro an option?
metastatic SCLC pts who have progressed after plat-based chemo and at least 1 prior line of therapy
T or F:
Pembro is used regardless of PD-1 status
true
what is the most efficacious modality for treatment of NSCLC
surgery
NSCLC: (low/moderately) sensitive to radiation and (low/moderately) sensitivity to chemo
moderately
low
NSCLC -> Resectable -> neoadjuvant -> surgery -> ?
chemo followed by immunotherapy or oral agent
neoadjuvant therapy:
__________ + a platinum doublet should be considered in those with tumors > __ or node positive
Nivolumab, 4
what is considered the standard of care for NSCLC?
adjuvant chemo
Preferred (non-squamous_ adjuvant therapy option
Cisplatin + Pemetrexed
(both IV)
Preferred (squamous)
Cisplatin + gemcitabine/docotaxel
NSCLC -> Unresectable -> ? and ?
chemo and radiation *
what to do in unresectable stage IIIB or IV
chemo + radiation
Stage III Unresectable Immunotherapy:
Now an option for pts who are not candidates for surgery or definitive chemo with radiation
Pembro, PD-L1 >1%
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
D
NSCLC advanced metastatic -> chemo + ________
targeted therapy
If a patient has a targetable mutation and is PD-L1 (+), it is preferred to use the _____ therapies first and then move to _________ later
oral
immunotherapy
exon 19 and 21 drug and any other shit you can think of
Osimertinib
T790M
EGFR targeting
T or F:
Osimertinib can cause QTC prolongation
true
dabraf cyp
3a4
dabraf underlined toxicities (2)
fevers, secondary skin cancers
Trametinib underlined toxicities (4)
fever
rash
visual changes
retinal detachment
which mutation is associated with smoking cigs?
A. ALK
B. EGFR
C. KRAS
D. PD-L
C. KRAS
PD-L1 positive of above >__% allows the use of pembro
1
treatment of metastatic NON-squamous:
Use of oral chemo
A. mutation negative
B. mutation positive
B
1st line NON-squamous
carboplatin+pemetrexed + pembro
treatment of metastatic squamous:
if no contraindication to immunotherapy
pembro or
pembro +chemo
or
atezolizumab or nivolumab or cemipilmab-rwlc
Treatment metastatic squamous:
if contraindication to immunotherapy
platinum doublet
in 1st line squamous carboplat is typically combined with what
gemcitabine or any of the -taxels
okay so after all of that shit theres a slide that says “new standard” for squamous NSCLC, what are the 3 drugs?
carboplat + pembro + paclitaxel
