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BPT Oncology > Lung > Flashcards

Lung Flashcards

1
Q

What proportion of new cancer dx in 2018 were lung?

A

9%

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2
Q

What percentage of cancer deaths are from lung ca?

A

18%

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3
Q

What is the most important carcinogen in cigarettes?

A

Polycyclic aromatic hydrocarbons

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4
Q

What are other risk factors?

A 
Occupation exposure
Second-hand smoke
Family history
EGFR mutation 
Internal cooking
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5
Q

What screening is evidence based? Why isn’t it recommended in Aus?

A

Yearly low dose CT scan in high risk persons

  • age 55-74
  • > 30 pack years
  • Smoking cessation <15years

False positive rate of 96%

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6
Q

What are some techniques for gaining tissue?

A 
Cytology
EBUS
Mediastinoscopy
Thorascopy
Thoracentesis 
Pleural fluid
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7
Q

What is the SN and SP for mediastinal LNs?

A

91% and 86%

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8
Q

What tumour factors mean immediate stage IV?

A

Pleural effusion

Tumour in contra-lateral lung

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9
Q

Mean survival and Mx of stage 1

A

60-80%

Surgery if medically fit. Stereotactic surgery if not fit.

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10
Q

Mean survival and Mx of stage 2

A

40-50%

Surgery if medically fit. Radiotherapy if not fit

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11
Q

What is the standard surgery?

A

Lobectomy with mediastinal LN dissection

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12
Q

When is adjuvant chemo recommended?

A

Stage II and IIIA (stage IB controversial)

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13
Q

What chemotherapy is used?

A

Platinum based

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14
Q

When is radiotherapy best given in relation to chemo?

A

Concurrently

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15
Q

What is the role of durvalumab in stage III lung Ca?

A

Maintain post primary chemoradiation

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16
Q

What is the mean survival of stage IV?

A

4-5 months

17
Q

What are the four tissue markers of importance for targeted therapy?

A

EGFR
ALK rearrangement
ROS 1
PDL-1

18
Q

What is the classic pathological classification?

A

Small-cell (15%) and non-small-cell (85%)

Non-small-cell

  • Squamous (30%)
  • Non-squamous (70%)

Non-squamous

  • Adenocarcinoma (90%)
  • Large-cell carcinoma (10%)
19
Q

Which pathological subtype has the worse prognosis?

A

Large-cell neuroendocrine

20
Q

Which pathology types should be tested for what marker?

A

All NSCLC - PDL1

Adenocarcinoma
- EGFR, ALK rearrangement, ROS1

21
Q

Which patients more commonly have EGFR mutant?

A

Asian

22
Q

What drug targets the EGFR mutant Ca

A

1st gen: Erlotinib
2nd gen: Gefitinib
3rd gen: Osimertinib

23
Q

What is the classic side effect of EGFR molecular therapy?

A

Acneiform rash - 80% get it

24
Q

What is the benefit of Osimertinib?

A

Overcomes T790 mutation that commonly leads to resistance to erlotinib and gefinitib

25
Q

How common is ALK rearrangement?

A

2-7% NSCLC

26
Q

What drug targets ALK rearrangement

A

Crizotinib

Alectenib (replaced crizotinib as standard of care)

27
Q

What are the side effects of ALK rearrangement targeting therapy?

A 
Visual changes 
Neutropenia
Altered bowel habit 
Pulmonary toxicity
Fluid retention 
Hepatotoxicity
Bradycardia
Prolonged QT 
Fatigue
Cytochrome p450 interactions
28
Q

What is the benefit of alectenib over crizotinib?

A

Less toxic, better CNS penetration

Hazard ratio for disease progression or death 0.5

29
Q

How common is ROA-1 rearrangement?

A

1% of NSCLCs

30
Q

Which medication targets ROA-1?

A

Crizotinib

31
Q

When are immunotherapies indicated?

A

1st line
2nd line
Adjuvant

32
Q

What markers do you check for prior to immunotherapy?

A

PDL1 status

33
Q

When is pemrolizumab alone first line?

A

When PDL1 is >50%

34
Q

What was the trial median overall survival with first line pembrolizumab

A

30months

35
Q

When is atezolizumab indicated?

A

Non-squamous for low PDL1 or progression on TKI for EGFR and ALK

36
Q

What is the next stage in pembrolizumab use?

A

Combination with chemo for first line regardless of PDL1 status

37
Q

When is a first line chemotherapy regimen is used?

A

Low PDL1

Not candidate for immunotherapy or not suitable

BPT Oncology (17 decks)

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