Lung And Colon Cancers

Question 1

What is the difference between a neoadjuvant and an adjuvant in the context of cancer treatment?

Answer 1

• Neoadjuvant = treatment given before definitive (curative) treatment
• Adjuvant = treatment given after attempt at cure to reduce chances of incurable recurrence

Question 2

What does ‘staging’ do?

Answer 2

• Defines prognosis - local, regional and distant spread (varies by tumour site)
• informs management (spread usually indicative of poor prognosis and may choose not to treat)

Question 3

What are the different ‘letters’ involved in tumour staging?

Answer 3

• T: size/depth of invasion
• N: presence or absence of lymph node invasion
• M: presence or absence of metastases

Question 4

Which cancer is the second most common in the U.K. but also the most common cause of cancer related death?

Answer 4

Lung cancer

Question 5

What are the most common types of lung cancer?

Answer 5

• Squamous cell carcinoma
• Small cell carcinoma
• Adenocarcinoma

Question 6

Does lung cancer usually present with advanced or non-advanced disease?

Answer 6

Advanced (stage 4)

Question 7

What is the median survival for lung cancer?

Answer 7

• poor prognosis: 10 months

Question 8

Newer agents for therapy in lung cancer have an interest in what?

Answer 8

Pharmacogenetics - Identifying subgroups more likely to benefit by looking at predictive markers

Question 9

Give an example of a specific cancer pathway and the drug targeting it

Answer 9

• EGFR pathway

- Cetuximab (chimaeric antibody)

Question 10

The presence of what is predictive of non-response to anti-EGFR therapy?

Answer 10

• KRAS mutation
• Cetuximab treatment only effective when used on tumours that are not KRAS-mutated
• also discovered BRAF and PIK3CA mutations that confer resistance

Question 11

What are the mutations of interest in the EGFR pathway?

Answer 11

• EGFR copy no
• EGFR activating mutation
• KRAS mutation
• PTEN mutation

Question 12

What EGFR mutations are being investigated as molecular markers?

Answer 12

• Activating mutations in Exons 19 and 21 of EGFR receptor
• Occurs in 30% Asian and 8% Caucasian
• Mutually exclusive with KRAS mutations

Question 13

Anaplastic lymphoma kinase is a recently discovered kinase whose aberration is important in anaplastic lymphoma and neuroblastoma but how does it have an effect in lung cancer?

Answer 13

• Fusion with ELM4 makes ELM4-ALK
• Arises through inversion in short arm of chr2
• Potent oncogene present in 4-7% of lung cancers

Question 14

What is the specific phenotype associated with ELM4-ALK in lung cancer?

Answer 14

• adenocarcinoma
• young patients
• light/never smoker

Question 15

What specific treatment is used for ELM4-ALK in lung cancer?

Answer 15

Crizotinib = tyrosine kinase inhibitor

Question 16

With which mutations/treatments do lung cancer patients live longer?

Answer 16

• EGFR activating mutations with tyrosine kinase inhibitor therapy
• ELM4-ALK fusion protein tumour

Question 17

Where does colorectal cancer sit in the league tables of cancer incidence and cancer deaths?

Answer 17

• Third most common cancer

- Second most common cause of cancer deaths

Question 17

Acquired Mismatch repair defects occur in what percentage of all colorectal tumours?

Answer 17

10-15%

Question 18

Almost all COlorectal cancers express what?

Answer 18

• EGFR

- makes it a good target for cetuximab therapy in those with no KRAS mutations