Exam 3 - Lung Cancer 2

Question 1

What are the first generation ALK inhibitors? (2)

Answer 1

crizotinib, ceritinib

Question 2

What are the second generation ALK inhibitors? (2)

Answer 2

alectinib, brigatinib

Question 3

What is the third generation ALK inhibitor?

Answer 3

lorlatinib

Question 4

What are AEs unique to second generation ALK inhbitors (alectinib, brigatinib)? (4)

Answer 4

anemia, HTN, LFT abnormalities and peripheral edema (alectinib)

Question 5

What are AEs unique to third generation ALK inhbitors (lorlatinib)?

Answer 5

CNS shit (mood disorders/cognitive defects/neuropathy)

Question 6

What are the KRAS inhibitors? (2)

Answer 6

sotorasib, adagrasib

Question 7

Describe the PKPD of sotorasib?

Answer 7

CYP3A4 substrate and strong P-gp inhibitor

Question 8

What are CIs for sotorasib?

Answer 8

coadministration with PPIs and H2RAs (4 hours before or 10 hours after)

Question 9

What are AEs of sotorasib?

Answer 9

N/D, fatigue, LFT abnormalities, musculoskeletal pain, decreased hemoglobin and lymphocytes

Question 10

Describe the PKPD of adagrasib?

Answer 10

CYP3A4 substrate and moderate CYP2B6/CYP2C9/P-gp inhibitor

Question 11

What are AEs of adagrasib?

Answer 11

same as sotorasib plus renal impairment, edema, QTc prolongation, interstitial lung disease/pneumonitis

Question 12

What are second line treatments for NSCLC with no previous checkpoint inhibitor? (3)

Answer 12

pembrolizumab, nivolumab, atezolizumab (immunotherapies)

Question 13

What are second line treatments for NSCLC with previous checkpoint inhibitor? (5)

Answer 13

docetaxel plus remucirumab, docetaxel alone (not preferred), gemcitabine, albumin-bound paclitaxel, pemetrexed (nonsquamous)

Question 14

What is treatment for Grade 1 immunotherapy related adverse effects?

Answer 14

continue immunotherapy

Question 15

What is treatment for Grade 2 immunotherapy related adverse effects?

Answer 15

hold immunotherapy and consider corticosteroid administration

Question 16

What is treatment for Grade 3 immunotherapy related adverse effects?

Answer 16

hold immunotherapy and prednisone 0.5-2 mg/kg/day until resolution to Grade 1 followed by at least 1 month taper

Question 17

What are treatments for refractory immunotherapy related adverse effects? (2)

Answer 17

add mycophenolate mofetil, infliximab

Question 18

What are the VEGF inhibitors? (2)

Answer 18

bevacizumab, ramucirumab

Question 19

What are AEs of VEGF inhibitors?

Answer 19

HTN (acute), thromboembolic events, epistaxis, major bleeds (GI perforation), proteinuria, diarrhea

Question 20

What are CIs for VEGF inhibitors?

Answer 20

those with squamous histology and other bleed risks

Question 21

What is first line for limited stage SCLC?

Answer 21

cis/carboplatin plus etoposide plus concurrent RT

Question 22

What is first line for extended stage SCLC? (3)

Answer 22

carboplatin plus etoposide plus atezoliz/durvalumab

Question 23

What is second line for SCLC? (3)

Answer 23

topotecan, lurbinectedin, clinical trial

Question 24

What is the MOA of etoposide?

Answer 24

topoisomerase II inhibitor (dsDNA breaks)

Question 25

What are AEs of etoposide?

Answer 25

myelosuppression, N/V, stomatitis, alopecia

Question 26

What is the MOA of topotecan?

Answer 26

topoisomerase I inhbitor (ssDNA breaks)

Question 27

What are AEs of topotecan?

Answer 27

myelosuppression (neutropenia), N/V/D, fatigue, alopecia

Question 28

What is the MOA of lurbinectedin?

Answer 28

alkylates DNA residues that ultimately result in DNA damage and cell death

Question 29

What are AEs of lurbinectedin?

Answer 29

nausea, fatigue, hepatic enzyme elevations, extravasation