Exam 2 - Lung Cancer Weddle Flashcards
___-___ % of lung cancers are associated with smoking
85-90%
______ mutations can predict sensitivity to TKI therapy, and is present in 10-15% of NSCLC
a. EGFR
b. KRAS
a. EGFR
_____ mutations predict resistance to TKI’s; in adenocarcinomas, mutations are exclusive to smokers, ~10-30% of NSCLC
a. EGFR
b. KRAS
c. ALK
d. ROS-1
b. KRAS
encodes a receptor kinase related to ALK; present in 1% of NSCLC
a. EGFR
b. KRAS
c. ALK
d. ROS-1
d. ROS-1
it is recommended to test in 1st line metastatic setting for NSCLC
a. ROS-1 mutation
b. BRAF V600E mutation
c. EGFR mutations
b. BRAF V600E mutation
T or F: PD-L1 testing is not recommended for SCLC
T
adenocarcinomas, squamous and non-squamous cells, and large cells fall under which class?
a. NSCLC
b. SCLC
a. NSCLC
Which NSCLC is being described below?
-most common in non-smokers
-tend to be located peripherally in the lung
a. adenocarcinoma
b. squamous
c. large cell
d. small cell
a. adenocarcinoma
Which NSCLC is being described below?
-clearly related to smoking
-tend to be located centrally in lung
a. adenocarcinoma
b. squamous
c. large cell
d. small cell
b. squamous
which NSCLC is being described below?
-tend to be located peripherally in the lung
-tend to be a diagnosis of exclusion
a. adenocarcinoma
b. squamous
c. large cell
d. small cell
c. large cell
what is being described below?
-related to smoking
-fast growing and rapidly progressive
-can have presence of paraneoplastic syndromes
a. adenocarcinoma
b. squamous cell carcinoma
c. large cell carcinoma
d. small cell carcinoma
d. small cell carcinoma
rank these in order of how common they are in types of lung cancer?
large cell, small cell, adenocarcinoma, squamous
adenocarcinoma (50%) > squamous (30%) > small cell (15%) > large cell (5%)
which of the following about SCLC and NSCLC is TRUE?
a. NSCLC has a clear relationship to smoking
b. paraneoplastic syndromes are common in NSCLC
c. SCLC is not sensitive to radiation and chemo
d. NSCLC has a slower growth fraction
d. NSCLC has a slower growth fraction
which of the following presents more commonly with metastases?
a. SCLC
b. NSCLC
a. SCLC (66% vs 50%)
limited vs extensive stage SCLC
-limited = tumor is confined to hemithorax and contained in a radiation port
-extensive = not confined to hemithorax of origin, not contained in a radiation port, distant metastasis
what is the median survival for extensive and limited stage SCLC without therapy?
extensive -> 6 weeks
limited -> 12 weeks
limited stage SCLC combo therapy
cisplatin + etoposide + radiation
platinum based combo chemotherapy WITHOUT radiation is preferred in _________ stage SCLC
a. limited
b. extensive
b. extensive
for extensive stage SCLC, first line regimens involve carboplatin, etoposide, plus what third drug? (2 options; slide 28-30)
atezolizumab, durvalumab
T or F: pembrolizumab is an option for metastatic SCLC after platinum-based chemo and at least 1 prior line of therapy, regardless of PD-1 status
T
what is the most efficacious modality for tx of NSCLC?
surgery
3 types of NSCLC
resectable, unresectable, advanced/metastatic
T or F: neoadjuvant chemotherapy is considered standard of care for NSCLC
F (adjuvant, not neoadjuvant)
how do we decide which chemotherapy will be used for NSCLC?
depends on histology, squamous vs non-squamous
which adjuvant therapy is preferred for non-squamous NSCLC?
a. cisplatin + pemetrexed
b. cisplatin + gemcitabine
c. cisplatin + docetaxel
a. cisplatin + pemetrexed
(non-squamous = pemetrexed)
if pt is not able to tolerate cisplatin, what can we change it to?
carboplatin
two drug options for unresectable stage II/III NSCLC after concurrent chemoradiation
-durvalumab
-osimertinib (if EGFR exon 19 deletion or L858R)
immunotherapy option for stage III unresectable NSCLC in pts who aren’t candidates for surgery or definitive chemotherapy with radiation
pembrolizumab
if a pt has a targetable mutation and is PD-L1 (+), it is preferred to use the _____ therapies first and then move to immunotherapy later
oral
BRAF mutations are present in ___-___ of adenocarcinomas
1-2%
agent for KRAS G12C mutation
sotorasib
which BRAF therapy has the following toxicities: fever, rash, and secondary skin cancers?
a. dabrafenib
b. trametinib
a. dabrafenib
which BRAF therapy has the following toxicities: fever, rash, visual changes, retinal detachment?
a. dabrafenib
b. trametinib
b. trametinib
drug for T790M mutation
a. alectinib
b. sotorasib
c. pembrolizumab
d. atezolizumab
e. osimertinib
e. osimertinib
pembrolizumab can be used in metastatic disease with PD-L1 positivity > ___ %
> 1%
(pembro or atez)
squamous NSCLC standard 3 drug regimen
carboplatin + paclitaxel + pembrolizumab
What laboratory values do we need monitor in patients receiving immunotherapy? (6 of them)
CBC, CMP, TSH, free T4, amylase, lipase
we can consider lung cancer screening for high-risk pts:
age ___-___, have a ___-pack year history of smoking and are still smoking or have quit in the past ___ years, good health, and are willing to have curative lung surgery if detected
55-75; 30; 15
What would be the preferred treatment regimen for someone with limited stage SCLC?
cisplatin + etoposide + radiation
