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CDM 4 Exam 3 > Lecture 9 - Lung cancer > Flashcards

Lecture 9 - Lung cancer Flashcards

1
Q

Who is considered “high risk” for lung cancer screening

A

50+ yrs old and 20+ pack per year history of smoking cigarettes

Low dose CT = highly sensitive and can have false results

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2
Q

Lung cancer risk factors

A

cigarette smoking hx
radon exposure
occupational exposure
cancer hx
family hx in 1st degree relative
disease hx, COPD or pulmonary fibrosis
Second-hand smoke exposure

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3
Q

Small cell lung cancer info

A

centrally located
rapid doubling time, ~ 30 days
High growth fraction
early development of widespread metastases
more closely linked to smoking

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4
Q

Adenocarcinoma info

A

most common, n most common among non-smokers
inc incidence
peripheral lesions
doubling time ~ 160 days

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5
Q

Squamous Cell carcinoma info

A

most resectable
centrally located
common among smokers
targetable mutations uncommon
slow grow, ~ 88 days doubling time
late development of metastases

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6
Q

Large Cell carcinoma info

A

incidence declining
peripherally located
often bulky in size and quickly spread
longer doubling time, ~ 86 days

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7
Q

How is SCLC staged

A

using VA Lung Study group classification system, rather than TNM

Limited vs Extensive

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8
Q

“Limited” SCLC

A

confined to ipsilateral hemithorax, which can be safely encompassed within a radiation field

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9
Q

“Extensive” SCLC

A

beyond ipsilateral hemithorax, including malignant pleural or pericardial effusion or hematogenous metastases

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10
Q

biomarker testing recommendations with non-squamous NSCLC

A

EGFR
ALK
ROS1
BRAF
MET
PD-L1
NTRK
RET
ERBB2

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11
Q

biomarker testing recommendations with squamous NSCLC

A

EGFR
ALK
ROS1
BRAF in select pts

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12
Q

NSCLC Stage I/II txm

A

resection if possible, goal is negative margins

Chemo after resection

chemoradiation combo, cisplatin based doublet is go to

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13
Q

point of neoadjuvant therapy NSCLC Stage I/II

A

shrink tumor and improve operability
convert inoperable to operable

after surgery = intention to cure/improve survival

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14
Q

Cisplatin (Platinol) toxicity

A

N/V/ nephrotoxicity, peripheral neuropathy, mild myelosuppresion, ototoxicity, hypokalemia, hypomagnesemia

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15
Q

Cisplatin (Platinol) toxicity prevention

A

Adequate Pre-/Post hydration
Mannitol
electrolyte replacement
Antiemetics

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16
Q

Carboplatin (Paraplatin) toxicity

A

myelosuppresion, neutropenia, thrombocytopenia, anemia, Nausea, vomiting, nephrotoxicity

  • Based on Calvert Formula*
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17
Q

Calvert Formula

A

AUC X (CrCl + 25)

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18
Q

Stage 3B disease info

A

concurrent chemo w/ radiation, typically cisplatin based followed by consolidate therapy

  • if unresectable w/ no progression after 2 cycles, can do Durvalumab Q2wk for 12 month*
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19
Q

Who is EGFR+ NSCLC more common in?

A

women
non-smokers w/ adenocarcinomas
asians

20
Q

Only drug that hits EGFR+ T790M mutation n all others is….

A

Osimertinib

21
Q

Which EGFR drugs need to be on empty stomach

A

Afatinib (Gilotrif)
Erlotinib (Tarceva)= no PPI***

rest can be taken w/ or without

22
Q

EGFR Rash and Management

A

worsening rash had better overall survival

non-pharm: moisturize dry areas BID, minimize sunlight exposure, use SPF 30, wash w/ bath or shower oil to trap moisture

23
Q

Some EGFR toxicities

A

inc eyelash length
Diarrhea
paronychia = periungual inflammation develops months later

24
Q

If ALK+, usually resistant to….

A

EGFR agents

25
Q

preferred agents for ROS Rearrangement

A

Crizontinib
Entrectinib = better CNS pen but more toxicity than Crizontinib

26
Q

ALK/ROS1 options

A

Alectinib = ALK+
Brigatinib = ALK+
Ceritinib = ALK+
Crizotinib = ALK/ROS1+
Entrectinib = ROS1+
Lorlatinib = ALK+

27
Q

BRAF mutation therapy

A

Dabrafenib + trametinib is recommended, V effective
V600E mutation = better prognosis

28
Q

MET EXON14 skipping mutation 1st line

A

Capmatinib

29
Q

RET Rearrangement mutation 1st line

A

Selpercatinib (wt based dosing) or pralsetinib

30
Q

NTRK Fusion mutation 1st line

A

Larotrectinib or entrectinib

31
Q

Immune checkpoint inhibitors are first line in pts that…

A

cant identify driver mutation

Atezolizumab, Nivolumab and Pembrolizumab

Durvalumab can be used as adjuvant

32
Q

PD-L1 testing rec for….

A

all pts with metastatic disease

33
Q

PD-L1 > 50%, Non-squamous preferred agents….

A

Pembrolizumab
Pembrolizumab + pemetrexed + carboplatin or cisplatin
Atezolizumab
Cemiplimab-rwlc

34
Q

PD-L1 > 50%, Squamous preferred agents…

A

Pembrolizumab + carboplatin +paclitaxel

35
Q

PD-L1 1-49%, non-squamous preferred agents….

A

Pembrolizumab + pemetrexed + carboplatin or cisplatin

36
Q

PD-L1 1-49%, squamous preferred agents…

A

Pembrolizumab + carboplatin +paclitaxel

37
Q

PD-L1 < 1%, non squamous preferred agents…

A

Pembrolizumab + pemetrexed + carboplatin or cisplatin

38
Q

PD-L1 < 1%, squamous preferred agents….

A

Pembrolizumab + carboplatin + paclitaxel
Pembrolizumab + carboplatin + albumin-bound paclitaxel

39
Q

immune checkpoint inhibitors

A

Atezolizumab = Tecentriq
Nivolumab = Opdivo
Pembrolizumab = Keytruda, req PDL1 testing

40
Q

immune checkpoint inhibitors ADE

A

can happens months to years later

within month = skin
2 months = GI
3 months = endocrine
4 month = lung

41
Q

VEG-F inhibitors

A

Bevacizumab
Ramucirumab

42
Q

Bevacizumab info

A

1st line in select pts with non squamous NSCLC

43
Q

Ramucirumab info

A

1st line or subsequent therapy in select pts

44
Q

Limited stage SCLC therapy

A

Cisplatin Day 1 + etoposide days 1-3, every 21 days for 4-6 cycles with radiation

45
Q

Extensive Stage SCLC therapy

A

Platinum/etoposide or platinum/irinotecan for 4-6 cycles

46
Q

Carboplatin advantages n disadvantages

A

Less N/V
Less neuropathy
Less nephropathy

More myelosuppresion
not as well clinically evaluated

47
Q

immunotherapy in extensive stage SCLC

A

Atezolizumab w/ carboplatin
Durvalumab w/ either platinum

CDM 4 Exam 3 (11 decks)

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