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PHARM 444 : Neurology/Oncology > Lecture 6 > Flashcards

Lecture 6 Flashcards

Lung cancer

1
Q

What are the leading risk factors of lung cancer ?

A

Smoking ( 1st and 2nd), Asbestos, COP, TB, lupus, immunosuppressive, exposure to radiation, pollution , beta carotene with smoking, certian chemicals exposure
Cannabis ? e-cigarette?

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2
Q

How often should people be screened ?

A

low dose of CT scane every 3 years in those ….

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3
Q

Who should be screened

A

55-74 years
15 yearsof smoking
30 pack per year

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4
Q

What are the S/S of Lung cancer?

A

cough, dyspnea, weight loss, chest pain and looks similar to COPD

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5
Q

Which type of lung cancer is most common among non-smokers ?

A

NSCLC - adenocarcinoma “gland”

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6
Q

What is the difference between mAb and small molecules ?

A

mAb mostlywork outside
small molecules - intracellular , not protein bound, short 1/2 lives and frequent dosing

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7
Q

What are the predictive biomarkers for NSCLC ?m

A

EGFR mutation
ALK rearrangement
ROS1 mutation
BR mutation
PDL-1+ ( >50%)
Predictive biomarker Negative

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8
Q

On the T cells what are the brakes and the gas pedals receptors ?

A

CTLA4 and PD1 –> Brakes , don’t kill
CD28 and OX40 –> kill

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9
Q

what is TPS in NSCLC?

A

Tmour proportion score
% of viable tumour celss showing PDL-1

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10
Q

What is Tx options for NSCLC stage 2 resectable ?

A

SurgerySurgery Resection
/ - Adjuvant
/- Adjuvant radiation or re-resection
Or EGFR + → osimertinib

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11
Q

What is the Tx options if stage 3 non - resectable ?

A

Radiation + chemo
Neoadjuvant
Adjuvant (chemo or radiation)
~ surgery ?!

Stage 3a - good response: durvalumab maintenance

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12
Q

What is the technique for NSCLC adjuvant tx?

A

Platinum doublet ( platinum + another)
Carboplatin or cisplatin
Vinorelbine or Gemcitabine

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13
Q

Tx for EGFR mutation ?

A

Osimertinib

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14
Q

Tx for PDL1 > 50% mutation ?

A

Atezolizumab/ Durvalumab

( stops the brake)

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15
Q

Tx for PD1 mutation ?

A

Nivolumab or pembrolizumab
(stops the break)

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16
Q

Tx for CTLA mutation ?

A

Ipilimumab
Stops the break

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17
Q

Why is carboplatin is prefered over cisplatin ?

A

less SE ( nausea, ototoxicity, nephrotoxicity)
More myelosuppression ( less WBCs risk)

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18
Q

Which medication would you use Calvert equation ?

A

Caboplatin

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19
Q

What is the MOA of vinorelbine ?

A

Vinca alkaloid
Inhibits cell growth by binding to tubulin on mitotic

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20
Q

what are the side effects of virorelbine ?

A

Myelosuppression
Changes to bowel ( constipation or diarrhea)
neuropathy
alopecia

bine –> bowel

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21
Q

What are the SE of gemcitabine ?

A

Bonne marrow suppression
Elevated liver function
pulmonary toxicity

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22
Q

When would you use pemetrexed ?

A

in the second agent for platinum doublet in PALLIATIVE care

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23
Q

What are the SE of premethexed ?

A

Bone marrow suppression
Diarrhea
Mucositis
Fatigue
Rash ( solution CS)

24
Q

What is a side effect prevention with premetrexed ?

A

Folic acid
Vitamin B12

25
Q

When would you use precision medicine ?

A

advanced or metastases
evidence of gene mutations

26
Q

Why is osimertinib so preferred and when should it be used ?

A

Used as the preferred EGFR TKI –> activity against resistance , better penetrance across BBB

ONLY indicated adjuvant and preferred metastatic

27
Q

For how long can you have osimertinib for adjuvant setting ?

A

up to 3 years

28
Q

Name EGFR TKi for lung cancer and when it would be used ?

A

Erlotinib
Gefitinib
Afatinib
Osimertinib *** ( can be in adjuvant)

mostly in advanced staged NSLCL

29
Q

If a patient comes in to pick up osimertinib ? what counselling point can you give ?

A

2 weeks can get rash like acne with papules and red , worse with sun
Diarrhea ( loperamide)
Fatigue

30
Q

What f/u and monitoring should you do for EGFR TKi medications - lung cancer ?

A

LFTs
QTc
Rash
Diarrhea
Other drugs like CYP3A4 : rifampin, anticonvulsants, macrolides

31
Q

Why might we want to use medications for ROS1 ?

A

it is a TK that plays a role in signalling of the cells .
Also a proto-ocogene

32
Q

What are the SE of Crizotinib vs Entrectinib ?

A

Crizo ( eye problem)
Entre ( Cognitive and CNS)

33
Q

What are the SE of Brigatinib?

A

More risk of highmBG, HTN, High CK

34
Q

What are the various TKI ( ROS1, ALK,EGFR) DDI ?

A

CYP 3A4
PH dependent
QT prolongation

35
Q

Which of the TKI ( ALK, ROS1, EGFR) needs a high fat meals for absorption ?

A

Alectinib

36
Q

What should a pt avoid while on TKI for lung cancer ?

A

3A4 - grapefruit
pH = PPI, H2 antagonist

37
Q

What are PDL1i ?

A

Atezolimuab and Durvalumab

38
Q

What are PD1i ?

A

Nivolumab and prembrolizumab

39
Q

Name PDL1i ?

A

PEDAL
Durvalumab
Atezolimuab

40
Q

What does PDL1 TPS > 50% ?

A

high expression of PD L1 on the tumour cells and pt would benefit from mAb Tx

41
Q

Looking at immune checkpoint Tx , pt has stage 2 lung cancer , PD>50% ?
recommended tx

A

Atezolizumab

42
Q

Looking at immune checkpoint Tx , pt has stage 3c lung cancer , PD>50% ?
recommended tx

A

Durvalumab

43
Q

Pt with Met-NSCLC with no driver mutations , what are the different tx ?

A

Platinum Doublet
ICI mono ( pembrolizumab)
Platinum doublet + ICI tx ( one or two)

43
Q

What does the research say about the use of CTL4i and PD1i ?

A

No clinical evidence now but is founded by the government

44
Q

If a patient has a low ECOG , which Tx would you recommend ?

A

Low chemo/radiation dose

45
Q

when is it appropriate to give durvalumab in NSLCL ?

A

curative - stage 3A
maintenance therapy ( after chemo+ radiation that had a good response)

46
Q

What is the main difference between SCLC limited vs extensive ?

A

Limited : in one area that can be treated with radiotherapy

Extensive: spread to nodes
Palliative pts

47
Q

What are the main point of SCLC ?

A

Highly linked to smoking
Grows fast and spreads easily
people get sick faster and reach stage 4

48
Q

What is the common metastase of lung cancer ?

A

brain

49
Q

What is the prime indication for etoposide ?

A

SCLC ( small cells lung cancer)

50
Q

If a patient has a good response to chemo and radiotherapy , what is the next step ?
SCLC limited .

A

prophylactic brain radiation

SCLC spread fast and grows fast

51
Q

What are the tx for extensive SCLC ?

A

Platinum doublet ( with etoposide)
PDL1

52
Q

What are the SE of etoposide ?

A

Hypotension while infusion
mucositis/ stomatitiss
Alopecia
Bone marrow suppression
Allergic / hypersensitivity rxn

53
Q

What is the MOA of etoposide ?

A

topoisomerase II inhibitor

54
Q

What is the oral bioavailibility of etoposide ?

A

Oral is approximately 50% bioavailable so dose of oral is usually increased
by a factor of 2 as compared to IV

PHARM 444 : Neurology/Oncology (10 decks)

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