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444-Oncology and Neurology > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

what is the leading cause of death from cancer

A

lung cance

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2
Q

RF for lung cancer

A

smoking (↑20x), second hand smoking (↑20-30%), asbestos, hx COPD/ TB/ lupus, immunosuppression, occupational exposure to certain chemicals, exposure to radiation, beta carotene with smoking, outdoor air pollution

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3
Q

S/S of lung cancer

A

cough, dyspnea, weight loss, chest pain, sx more likely in pts who already have COPD

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4
Q

lung cancer diagnosis requries

A

CXR, chest CT or PET, bronchoscopy, sputum cytology from cough or bronchoscopy, biopsy via bronchoscopy or fine needle or excisional or from surgery

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5
Q

year for 3 years
lung cancer workup includes

A

lab tests, consider bone scale, CT/MRI head, CT chest/ abdomen for bone/ brain/ liver/ adrenal metastasis, pulmonary fxn tests

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6
Q

CTFPHC recommends screening with low dose CT every _____in adults who: Are _____yrs, current or former smokers who quit in the last __yrs, min ______ year hx of smoking

A

every year for 3 years
55-74yrs
15 yrs
30 pack year

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7
Q

lung cancer is divided into 2 histologic types

A

non small cell lung cancer
small cell lung cancer

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8
Q

prognosis of stage 1 NSCLC

A

80% 5yr survival

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9
Q

prognosis of stage 4 NSCLC

A

10% 5yr survival

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10
Q

NSCLC is further divided into

A

adenocarcinoma (nonsequamous)
squamous cell (epidermoid)
other (large cell)

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11
Q

what is the most common type of NSCLC in nonsmokers

A

adenocarcinoma (nonsquamous)

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12
Q

what type of cells do adenocarcinomas affect

A

glandular cells

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13
Q

what type of cells do squamous cell NSCLC affect

A

squamous cells

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14
Q

treatment for stage 1-3A resectable disease

A

resection preferred, but pt has to be fit for surgery
+ adjuvant chemo if => stage 2
+ adjuvant radiation or reresecting after adjuvant chemo if + margins

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15
Q

what proportion of pts have nonresectable lung cancer

A

2/3- includes those who refuse or are unfit for surgery

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16
Q

options for stage 2-3 unresectable disease

A

concurrent radiation + chemo - if good response on stage 3A = give durvalumab
intense focused radiation, followed by adjuvant chemo
neoadjuvant chemo, surgery, adjuvant radiation

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17
Q

what is a platinum doublet

A

platinum + other drug

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18
Q

recommendation for stage 1-3A, ECOG 3-4

A

palliative radiation

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19
Q

cisplatin MOA

A

covalently binds DNA and disrupts function

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20
Q

cisplatin SEs

A

ototoxicity, nephrotoxicity, hypokalemia, hypomagnesemia, myelosuppression, N/V

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21
Q

what should be given with cisplatin infusions

A

K and Mg supplementation + IV fluid

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22
Q

what is dosed based on the carvert formula

A

carboplatin

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23
Q

what is the benefit of carboplatin over cispatin

A

less ototoxic and nephrotoxic

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24
Q

what is the downside of carboplatin over cisplatin

A

more myelosuppressive

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25
what is often used for pts who can't tolerate cisplatin due to renal insuff?
carboplatin
26
vinorelbine is a
semisynthetic vinca alkaloid
27
vinorelbine MOA
inhibits cell growth by binding to tubulin on nitotic MT
28
vinorelbine SEs
bone marrow suppression changes in bowel habits (constipation>diarrhea) sensory neuropathy alopecia
29
pemetrexed is an
antifolate antimetabolite
30
pemetrexed is an antifolate antimetabolite that primarily
inhibits thymidylate synthase which leads to reduced thymidine for DNA synthesis
31
pemetrexed SEs
bone marrow suppression diarrhea mucositis fatigue skin rash (less if pretreat with dex)
32
how to prevent pemetrexed bone marrow suppression, diarrhea, mucositis
folic acid 0.4mg po daily starting 1 wk before first dose + cont 3 wks after last dose vit B12 1000mcg IM q9wks with first inj 1 wk before first dose, end 3 wks after last dose
33
gemcitabine MOA
pyrimidine analog whos active metabolites are incorporated into DNA = inhibition of DNA synthesis + induction of apoptosis
34
gemcitabine AEs
bone marrow suppression elevated liver enzymes pulmonary toxicity
35
durvalumab is indicated in pts that are (3)
stage 3A NSCLC and have received concurrent chemo + radiation and has good response to tx (no progression)
36
durvalumab is an ________ that blocks ________
immune checkpoint inhibitor that blocks PD-L1
37
how to treat advanced (stage 3B, C) or metastatic lung disease if ECOG 3-4
radiation alone
38
how to treat advanced (stage 3B, C) or metastatic lung disease if ECOG is 1-2
chemo +/- radiation- platinum doublet targeted oral therapies - EGFR TKis, ALK TKis, ROS1 TKIs immune checkpoint inhibitors
39
Genetic mutations and molecular targets can be identified through _____. ______ can detect presence of PD-L1 in tissues
PCR, FISH, NGS IHC
40
NSCLC adenocarcinoma can be further detailed into
EFGR mutation ALK fusion oncogene ROS1 rearrangement positive KRAS mutation
41
T or F: the overlap between NSCLC is rare
T <3%
42
common EFGR sensitizing mutations are ______ or _______
deletion exon 19 point mutation exon 21
43
what is a less common EGFR mutation
T790M
44
what is true about T790M? select all that apply 1. is a less common EGFR mutation 2. is a common ALK fusion mutation 3. tends to be hereditary 4. tends to be acquired during treatment
1,4
45
sensitizing EGFR gene mutations are more common in _____ and ______
smokers and females
46
what are the first gen EGFR TKIs
erlotinib and gefitinib
47
what is the second gen EGFR TKi
afatinib
48
what is the third gen EGFR TKi
osimertinib
49
all EGFR TKis have activity on ______ or ______
exon 19 del or exon 21
50
what is the only EGFR TKi that has activity on T790M
osimertinib
51
what EGFR TKi is funded as first line for EGFR sensitizing mutation in alberta
osimertinib
52
osimertinib benefits
better penetration to brain- passes BBB only EGFR TKi that targets T790M
53
AEs for EGFR TKis
fatigue, rash, diarrhea, hepatic dysfunction or increase in liver transaminases, interstitial lung disease
54
what are 2 ALK fusion oncogene TKis
alactinib and brigatinib
55
name 3 ALK TKi AEs
GI toxicities - diarrhea (50% with brig), constipation (35% with alect) N/V (30% with brig) hepatotoxicity or elevation in transaminases and/or bilirubin hyperglycemia with brig (initiate appropriate AHG meds) myalgia with alectinib symptomatic bradycardia QTc prolongation HPTN with brig CK elevation
56
ROS1 encodes a _____ and is a _____
Transmembrane receptor protooncogene
57
what are 2 ROS TKis
entrectinib and crizotinib
58
which of the following is true about the KRAS mutation 1. it happens in about 40% of all lung NSCLC adenocarcinoma 2. if it is present, there is likely problems with either EGFR, ALK, ROS1 3. is a good prognostic marker 4. if it is present, EGFR, ALK, ROS1 are unlikely to have mutations too 5. EGFR targets may help
4
59
entrectinib is a
ROS1 fusion TKi
60
osimertinib is a
EGFR TKi
61
which of the following should be taken with or without food 1. osimertinib 2. entrectinib 3. crizotinib 4. alectinib 5. brigatinib
1, 2, 5
62
which of the following should be taken with food 1. osimertinib 2. entrectinib 3. crizotinib 4. alectinib 5. brigatinib
4
63
which of the following has pH dependent solubility 1. osimertinib 2. entrectinib 3. crizotinib 4. alectinib 5. brigatinib
2
64
osimertinib, entrectinib, crizotinib, alectinib, and brigatinib are major CYP ____ substrates
3A4
65
crizotinib is a TKi for
ROS1
66
alectinib is a TKi for
ALK
67
brigatinib is a TKi for
ALK
68
because erlotinib, gefitinib, osimertinib, entrectnib, crizotinib, alectinib, brigatinib = major CYP3A4 substrate, what should be avoided? what should be monitored?
avoid grapefruit juice monitor INR for pts on warfarin
69
what are 4 treatment options for NSCLC nonsquamous with out driver mutations
platinum doublet ICI monotherapy platinum doublet with one ICI therapy platinum doublet with 2 ICI therapies
70
Regardless of PD-L1 expression levels, immunotherapy is less effective for__________- if there is a driver in metastatic disease, use that as a target first
tumors with driver mutations (EGFR+, ALK+)
71
if a tumor has high PD-L1 levels and an EGFR mutation, which would be more appropriate therapy 1. osimertanib 2. entrectinib 3. pembrolizumab 4. platinum doublet 5. imilimumab
1- EGFR TKi always target driver mutations first, before using immunotherapy agents
72
where are PD-1 receptors present?
activated cytotoxic T cells
73
where are PD-L1 ligands present
cancer cells
74
PD-1 inhibit MAbs include
nivolumab, pembrolizumab
75
PD-L1 inhibitors include
atezolizumab, durvalumab
76
what is a tumor proportion score?
% of viable tumor cells showing any PD-L1 staining (not the same as somatic genetic mutation)
77
what is the best for predicting response to pembrolizumab in metastatic NSCLC
PD-L1TPS
78
the TPS predicts response of metastatic NSCLC to ______ 1. pembro 2. nivo 3. atezo 4. durvalu 5. more than one of the above
1
79
which of the following is true about PD-L1 1. TPS is a measure of the % of tumor cells with PD-L1 staining 2. >50% is a high expression and chooses pembro as second line therapy 3. expression is continuously variable and dynamic, hence cut offs are arbitrary 4. >1% is high expression = pembro is second line therapy
3
80
if PD-L1 expression is >50% without other driver mutations, what is first line therapy?
pembrolizumab
81
in order to use immune checkpoint inhibitors like pembrolizumab, pts must have ______
ECOG <2
82
what is the only PD-1/PD-L1 inhibitor used with a curative intent
durvalumab for stage 3A
83
pembrolizumab may be combined with __________ for improved 1 yr survival compared to chemo alone
platinum doublet for improved 1yr survival compared to chemo alone
84
when may pembrolizumab be second line
after progression if the pt did not receive pembro before and PD-L1 =>1
85
nivolumab is a
PD-1i
86
nivolumab is used with ______ intent
palliative for advanced/ metastatic
87
nivolumab is used as first line in combo with
ipilmumab and platinum doublet if no mutations
88
is PD-L1 score required if nivo is used as first line in combo with ipilumab and platinum coublet?
no
89
when is nivo indicated as second line tx
after progression on chemo alone
90
when is atezolizumab used
for palliation after advanced/ metastatic + second line only after rpogression on chemo alone
91
durvalumab can be used for
curative intent for stage 3A and consolidation (prevent recurrance) adjuvant- after good response on concurrent chemo + radiation
92
B7 is present on
dendritic cells
93
CD28 is on
T cells
94
CTLA4 is an
immune checkpoint
95
______ is a CTLA4i
ipilimumab
96
ipilimumab is synergistic with
PD1 targeting MAbs like nivolumab
97
data supports the combo of ipilimumab + _______ + ______
nivolumab + chemo
98
what is a spectrum of SEs caused by general immunologic enhancement
immune mediated AEs
99
what is considered limited SCLC
cancer contained in single area that can be treated with radiotherapy
100
can limited SCLC be treated with curative intent?
yes- if pt is fit
101
what is considered extensive SCLC
cancer has spread to other lung or lymph nodes further away from cancer distance metastasis present may be in pleural fluid
102
extensive SCLC is treat with ____ intent
palliative
103
SCLC is highly linked to
smokign
104
which spreads and grows faster? NSCLC or SCLC?
SCLC
105
SCLC usually starts in cells that
line the bronchi (center of lung)
106
describe stage 1 SCLC
3.5% pts diagnosed here, 5yr survival of 30%
107
should you push stage 1 SCLC pts to quit smoking?
yes- 5 yr survival doubles if they stop smoking after dx
108
describe stage 4 SCLC
67% dx here, 5yr survival 2%, most survive for 7-11mths after
109
treatment of limited stage SCLC
concurrent chemo + radiation for pts with ECOG 0-1 prophylactic cranial radiation for brain metastasis
110
treatment of extensive stage SCLC
platinum doublet chemo 4-6 cycles + durvalumab + durvalumab maintenance
111
etoposide is used in lung cancer in
SCLC

444-Oncology and Neurology (22 decks)

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