Exam 3 - Lung Cancer 1 Flashcards
Compare small cell lung cancer (SCLC) to non-small cell lung cancer (NSCLC) characteristics?
smoking affects more, higher metastasis at diagnosis and lower survival without treatment, tumor growth rate faster, worse prognosis
List the signs/symptoms of lung cancer?
pulmonary symptoms (cough, dyspnea, chest pain), repeat prescriptions for pneumonia/bronchitis/chronic cough, extra-pulmonary symptoms (fatigue, weight loss), superior vena cava syndrome, paraneoplastic syndromes
List the risk factors for lung cancer?
smoking, asbestos and metal exposures, radiation
What is the formula for pack years?
pack years = years of smoking*number of packs/day smoked
Define neoadjuvant therapy? Adjuvant?
neoadjuvant = prior to surgical intervention (Now), adjuvant = after surgical intervention (After)
What are neoadjuvant regimens for perioperative therapies in NSCLC? (3)
nivolumab plus platinum-based chemo for 3 cycles, pembrolizumab plus cisplatin-based chemo for 4 cycles, platinum-based chemo for 4 cycles
What are adjuvant regimens for perioperative therapies in NSCLC? (4)
osimertinib, atezo/pembrolizumab, platinum based chemo for 4 cycles
What is platinum-based chemo for non-squamous histology in NSCLC?
cisplatin/pemetrexed
What are platinum-based chemo for squamous histology in NSCLC? (2)
cisplatin/docetaxel, cisplatin/gemcitabine
What are platinum-based chemo for patients who are not candidates for cisplatin in NSCLC? (3)
carboplatin/paclitaxel, carboplatin/gemcitabine, carboplatin/pemetrexed
What are AEs of platinum-based therapies? (6)
myelosuppression (carbo > cis), N/V (cis > carbo), D/C, nephro/ototoxicity (cis > carbo) and peripheral neuropathy (cis > carbo)
What is the formula for ideal body weight (IBW)?
male = 50 + 2.3 (height in inches - 60), female = 45.5 + 2.3 (height in inches - 60)
What is the formula for adjusted body weight? When is it used?
IBW + 0.4 (ABW - IBW); if actual body weight is 1.2 x IBW (obese patients)
When is actual body weight used?
if body weight is less than IBW (underweight patients)
What is the Cockroft-Gault equation?
CrCL (mL/min) = [(140 - Age) x weight in kg]/(72 x SCr) … x 0.85 if female
What is the Calvert equation?
Total dose (mg) = Target AUC x (CrCL + 25)
What is the MOA of taxanes?
inhibits mitosis through disruption of microtubule depolymerization
Describe the PKPD of taxanes?
CYP3A4 substrate and CYP2C8 (paclitaxel only)
What are AEs of taxanes?
myelosuppression, alopecia, peripheral neuropathy, mucositis, N/V/D, hypersensitivity reaction (solvent related), peripheral edema (docetaxel)
What is the MOA of pemetrexed?
inhibits dihydrofolate reductase (DHFR) and thymidylate synthase (TS), thereby depleting DNA building blocks
Describe the PKPD of pemetrexed?
primarily renal elimination (avoid if CrCL <45 mL/min)
What are AEs of pemetrexed?
myelosuppression, rash, fatigue, N/V/D
What are the first generation epidermal growth factor receptor (EGFR) inhibitors?
erlotinib, gefitinib, afatinib
What is the second generation epidermal growth factor receptor (EGFR) inhibitor?
dacotaminib
What is the third generation epidermal growth factor receptor (EGFR) inhibitor?
osimertinib (first line)
What are AEs unique to third generation EGFR inhibitors (osimertinib)? (2)
myelosuppression, QTc prolongation
List recommendations for EGFR inhibitor rash management?
sun safety (SPF25), gentle skin care (loose fitting clothing, pH neutral bath chemicals, avoidance of OTC acne products, hydrophilic creams)
What are treatments for Grade 1 (mild) EGFR inhibitor rash management?
continue anticancer agent, hydrocortisone, clindamycin
What are treatments for Grade 2 (moderate) EGFR inhibitor rash management?
continue anticancer agent, hydrocortisone, doxy/minocycline
What are treatments for Grade 3 (severe) EGFR inhibitor rash management?
delay treatment for 1-2 weeks, continue Grade 1 and 2 interventions AND prednisone x7days
