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PHRM 864 > Exam 2: Lung Cancer > Flashcards

Exam 2: Lung Cancer Flashcards

1
Q

EGFR Mutations: Lung Cancer

A
  • can predict sensitivity to TKI therapy
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2
Q

KRAS mutations: Lung Cancer

A
  • can predict resistance to TKIs
  • exclusive to smokers
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3
Q

ALK inhibition: Lung cancer

A
  • present in non/light smokers, younger age, adenocarcinoma
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4
Q

ROS-1 mutations: Lung Cancer

A
  • encodes receptor kinase related to ALK
  • present in never/light smoker, adenocarcinomas, younger patients
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5
Q

BRAF V600E

A
  • typically current or former smokers
  • recommended to test in 1st line metastatic setting for NSCLC
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6
Q

PD-L1 Status

A
  • patients with EGFR, ALK, or ROS-1 mutation rearrangements typically done have PD1 expression
  • testing not recommended for SCLC
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7
Q

When to check PD-L1 status

A

1st line metastatic setting setting

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8
Q

NSCLC Histology Adenocarcinoma

A
  • 50% adenocarcinoma
  • most common in non-smokers
  • tend to be located peripherally in the lung
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9
Q

NSCLC Histology Squamous

A
  • 30%
  • clearly related to smoking
  • tend to be located centrally in lung
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10
Q

NSCLC Histology Large Cell

A
  • 5%
  • tend to be located peripherally in the lung
  • tend to be a diagnosis of exlusion
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11
Q

SCLC Histology

A
  • 15%
  • related to smoking
  • fast growing and rapidly progressive
  • can have presence of paraneoplastic syndrome
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12
Q

NSCLC Characteristics

A
  • slower growth fraction
  • moderatly sensitive to radiation
  • marginal sensitivity to chemo
  • 50% present with metastases
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13
Q

SCLC Characteristics

A
  • clear relationship to smoking
  • paraneoplastic syndromes common
  • rapid cell growth fraction
  • highly sensitive to radiation and chemotherapy
  • two thirds present with matastases
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14
Q

Presentation of Lung Cancer

A
  • very nonspecific
  • cough
  • spitting up blood
  • dyspnea
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15
Q

SCLC Limited Stage

A

tumor is confined to hemithorax and contained in a radiation port

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16
Q

SCLC Extensive Stage

A
  • tumor not confined to hemithorax or origin
  • not contained in a radiation port
  • distant metastasis
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17
Q

Is surgery a therapeutic option in SCLC

A

no

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18
Q

Limited Stage SCLC treatment

A
  • curative intent
  • radiation + combo chemo
  • radiation given concurrently daily
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19
Q

Chemo regimen in limited stage SCLC

A
  • platinum doublet
  • Cisplatin and Etoposide w/daily radiation
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20
Q

Extensive stage SCLC treatment

A
  • rarely curative
  • platinum based combo chemo without radiation
  • cisplatin or carboplatin-based combo
  • etoposide or irinotecan
21
Q

When is radiation appropriate for extensive stave SCLC

A
  • prophylactic cranial radiation if a patient achieves a response in the chest
  • if brain metastases present, whole brain radiation should be given
  • if symptomatic, whole brain radiation should be started prior to chemo
  • if asymptomatic, initiate radiation after chemo
22
Q

Immunotherapy SCLC Extensive Stage

A

Atezolizumab + Carboplatin + Etoposide

Durvalumab + Carboplatin + Etoposide

23
Q

Platin-based regimen toxicity

A
  • myelosupression
  • nephrotoxicity
24
Q

PD-1 Inibitors SCLC

A
  • option for metastatic SCLC patients who have progressed on or after platinum based chemo and at least 1 prior line of therapy
  • regardless of PD-1 status
25
Q

NSCLC Treatment Modalities

A
  • moderately sensitive to radiation
  • low sensitivity to chemo
  • Surgery is most efficacious
  • radiation for early stage when surgery cannot be performed
26
Q

Neoadjuvant Treatment of Resectable NSCLC

A
  • nivolumab + platinum doublet with tumors ≥ 4 cm or node positive and no contraindications
27
Q

Preferred non squamous resectable NSCLC Adjuvant Therapy Option

A
  • Cisplatin + pemetrexed
28
Q

Preferred squamous NSCLC resectable Treatment

A

Cisplatin +
- gemcitabine
- docetaxel
- vinorelbine
- etop

29
Q

Alternative adjuvant NSCLC resectable therapy option for those not able to tolerate cisplatin

A

Carboplatin +
- paclitaxel
- gemcitibine
- Pemetrexed (nonsquamous only)

30
Q

ALK positive and early stage resectable NSCLC

A
  • alectinib
31
Q

EGFR mutation exon 19/21 resectable NSCLC treatment

A

osimertinib

32
Q

Additional adjuvant resectable NSCLC treatment

A
  • atezolizumab
  • pembrolizumab
33
Q

Treatment for Unresectable Nonsquamous NSCLC (Stage IIIB/IV)

A
  • treatment considered palliative
  • platinum doublet chemo + radiation
  • cisplatin/carboplatin + pemetrexed/paclitaxel/etop
34
Q

Treatment for Unresectable squamous NSCLC (Stage IIIB/IV)

A
  • Paclitaxel + carboplatin (fewer toxicities)
  • cisplatin + etoposide
35
Q

Stage III unresectable NSCLC Immunotherapy

A
  • pembrolizumab an option for non-candidates for surgery or chemo/radiation
  • durvalumab for disease that has not progressed following chemo/radiation
36
Q

Utilizing TKIS in metastatic adenocarcinoma NSCLC

A
  • if patient has targetable mutation and is PD-L1+, it is preferred to use the oral therapies first and then move to immunotherapy
37
Q

EGFR Targeted therapies in metastatic adenocarcinoma NSCLC

A

Osimertinib (T790 Mutation)

38
Q

BRAF Targeted therapies in metastatic adenocarcinoma NSCLC

A

Dabrafenib + Trametinib

39
Q

KRAS G12C Targeted therapies in metastatic adenocarcinoma NSCLC

A

Sotorasib

40
Q

If no mutation found in metastatic NSCLC adenocarcionma or if targeted oral chemo have been exhausted for a positive mutation

A
  • check PDL1 status
  • if positive, Keytruda
41
Q

Mutation negative nonsquamous NSCLC

A
  • carboplatin + pemetrexed + pembrolizumab
42
Q

Treatment for Metastatic squamous NSCLC if no contraindication to immunotherapy

A
  • pembro OR
  • pembro + chemo OR
  • Atezolizumab or Nivolumab or Cemiplimab-rwlc
43
Q

Treatment for Metastatic squamous NSCLC if contraindication to immunotherapy

A
  • platinum doublet regardless of PDL1 status
44
Q

First line for Squamous Cell NSCLC

A
  • platinum doublet
45
Q

Carboplatin is typically paired with

A
  • gemcitabine OR
  • paclitaxel OR
  • nab-paclitaxel OR
  • Docetaxel
46
Q

Squamous NSCLC standard 3 drug regiment

A
  • pembro + carboplatin + paclitaxel (or albumin bound paclitaxel)
47
Q

Next line of therapy for metastatic squamous cell NSCLC

A
  • TKI if positive
  • Immunotherapy or non-platinum therapy
48
Q

Immunotherapy toxicities

A
  • rare and serious
  • pneumonitis
  • colitis
  • hepatitis
  • nephritis
  • endocrine (thyroid/pituitary)
49
Q

Lung Cancer Screening

A
  • can consider screening in patients considered high risk
  • no effective screening methods
  • false positives
  • no cost-effectiveness data

PHRM 864 (10 decks)

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