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PHM 703- Oncology, Hematology > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Calvert equation for carboplatin dosing

A

Total dose (mg)= (AUC) * (CrCl+25)

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2
Q

When to use IBW vs. ABW vs. AdjABW in CrCl formula

A

Use AdjABW when ABW/IBW >1.2
Use IBW when ABW/IBW <1.2
Use ABW when ABW < IBW

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3
Q

Lung cancer immunotherapy-related AE grade treatment plan: Grade 1

A

continue immunotherapy

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4
Q

Lung cancer immunotherapy-related AE grade treatment plan: Grade 2

A

hold immunotherapy and CONSIDER corticosteroid administration

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5
Q

Lung cancer immunotherapy-related AE grade treatment plan: Grade 3 and higher

A

hold immunotherapy and administer corticosteroid

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6
Q

Lung cancer immunotherapy-related AE grade treatment plan: refractory cases

A

Add infliximab, MMF

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7
Q

Corticosteroid dosing

A

Prednisone 0.5-2mg/kg/day or equivalent until resolution to Grade 1 followed by taper over at least 1 month

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8
Q

NSCLC treatment goal: Stages I and II

A

Cure!

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9
Q

Stage 1 NSCLC treatment

A

surgery and surveillance

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10
Q

Stage 2 NSCLC treatment

A

surgery, adjuvant therapy

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11
Q

NSCLC adjuvant therapy (mainstay of treatment)

A

Platinum-based regimen x4 cycles

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12
Q

Platinum-based regimens

A

Cisplatin/etoposide
Cisplatin/vinorelbine
Carboplatin/paclitaxel
Cisplatin/pemetrexed

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13
Q

Platinum-based regimens are for what kind of histology?

A

Nonsquamous

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14
Q

Cisplatin and carboplatin AEs

A

Myelosuppression
N/V/D
Constipation
Mucositis
Alopecia
Nephrotoxicity
Ototoxicity
Peripheral neuropathy

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15
Q

Carboplatin has less what compared to cisplatin (in terms of AEs)

A

N/V, nephrotoxicity, ototoxicity, peripheral neuropathy

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16
Q

Cisplatin nephrotoxicity

A

Hypokalemia, hypomagnesmia

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17
Q

Carboplatin myelosuppression

A

Thrombocytopenia

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18
Q

Adjuvant therapy in EGFR+ NSCLC

A

osimertinib for up to 3 years or until disease progression or unacceptable toxicity

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19
Q

Adjuvant therapy in PD-L1 ≥1% NSCLC

A

Atezolizumab following completion of platinum-based chemo x1 year

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20
Q

Neoadjuvant therapy for NSCLC for operable, but difficult to resect tumors

A

Platinum-based regimen +/- nivolumab x4 cycles

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21
Q

Radiation therapy in NSCLC

A

Reserved in conjunction with chemo (platinum-based) in patients who are medically inoperable
Positive margins after initial resection if unable to undergo resection
Concurrent rather than sequential chemo is preferred

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22
Q

NSCLC treatment goals: Stages III and IV

A

prolongation of survival

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23
Q

Stage IIIA NSCLC treatment

A

Neoadjuvant chemo +/- nivolumab x4 cycles followed by surgery or RT
Adjuvant osimertinib (EGFR+) or atezolizumab (PD-L1 ≥1%) similar to stage II
Concurrent chemoradiotherapy for non-surgical candidates

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24
Q

Stage IIIB-IIIC NSCLC treatment

A

Considered UNRESECTABLE DISEASE

Concurrent chemoradiation is the mainstay for up to 6 cycles or until progression or unacceptable toxicity

Durvalumab maintenance x1 year upon response to chemoradiotherapy

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25
Q

Stage IV NSCLC: targetable genetic mutation treatment

A

Kinase inhibitor targeted to the mutation

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26
Q

Stage IV NSCLC: PD-L1 positive ≥1%

A

PD-1/PD-L1 inhibitor +/- chemo

27
Q

Stage IV NSCLC: PD-L1 <1%

A

PD-1/PD-L1 inhibitor + chemo

28
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: PD-L1 ≥50%

A

pembrolizumab, atezolizumab, cemiplimab

29
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: PD-L1 1-49% or <1% with squamous histology

A

cisplatin or carboplatin + paclitaxel + pembrolizumab OR nivolumab AND ipilimumab

30
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: PD-L1 1-49% or <1% with nonsquamous histology

A

cisplatin or carboplatin + pemetrexed + pembrolizumab OR nivolumab AND ipilimumab

31
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: PD-L1 1-49% or <1% with squamous histology AND CIs EXIST

A

Cisplatin + gemcitabine

32
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: PD-L1 1-49% or <1% with nonsquamous histology AND CIs EXIST

A

Carboplatin + pemetrexed

33
Q

SCLC treatment goal: limited stage

34
Q

SCLC treatment goal: extensive stage

A

prolongation of survival

35
Q

First-line treatments for limited stage SCLC

A

Cisplatin OR carboplatin PLUS etoposide

36
Q

First-line treatments for extensive stage SCLC

A

Cisplatin OR carboplatin PLUS atezolizumab OR durvalumab

37
Q

Osimertinib AEs

A

Skin rash
Dry skin
Diarrhea
Fatigue
Stomatitis
Nail toxicity
Myelosuppression
QTc prolongation
Conjunctivitis (rare)

38
Q

Osimertinib clinical pearls (4 of them: CNS activity, tolerability, substrate of what CYP enzyme, pH-dependent absorption?)

A

Improved CNS activity compared to other EGFR targeting agents

Tolerability is better compared to other EGFR targeting agents

CYP3A4 substrate

No pH-dependent absorption

39
Q

ALK inhibitors (just the drugs)

A

Brigatinib, alectinib, lorlatinib

40
Q

Brigatinib AEs

A

Diarrhea
Fatigue
Interstitial lung disease/pneumonitis
Myalgia
HTN

41
Q

Brigatinib clinical pearls (4 of them: it vs. chemo, substrate of what CYP enzyme, pH-dependent absorption, dose reduction)

A

Demonstrated to be superior to chemo
2nd and 3rd gen > 1st gen

CYP3A4 substrate

No pH-dependent absorption

Dose reduction required for severe renal and hepatic impairment

42
Q

Alectinib AEs

A

Constipation
Fatigue
LFT abnormalities
Peripheral edema
Myalgia
Anemia

43
Q

Alectinib pearls (4: it vs. chemo, substrate of what CYP enzyme, pH-dependent absorption, dose reduction)

A

Demonstrated to be superior to chemo
2nd and 3rd gen > 1st gen

CYP3A4 substrate

No pH-dependent absorption

Dose reduction required for severe hepatic impairment

44
Q

Lorlatinib AEs

A

Fatigue
Peripheral edema
Mood disorders
Neuropathy
Cognitive effects
Arthralgia
Dyslipidemia/weight gain

45
Q

Lorlatinib pearls (5 of them: it vs. chemo, substrate of what enzymes, pH dependent absorption, CNS activity, dose reduction)

A

Demonstrated to be superior to chemo
2nd and 3rd gen > 1st gen

CYP3A4 and P-gp substrates

No pH-dependent absorption

Better CNS penetration, so more cognitive AEs

Dose reduction required for severe renal impairment

46
Q

KRAS inhibitors

A

Sotorasib, adagrasib

47
Q

Sotorasib AEs

A

Diarrhea
Nausea
Fatigue
LFT abnormalities
Musculoskeletal pain
Decreased Hgb/lymphocytes

48
Q

Sotorasib pearls (2: substrate and inhibitor of what enzymes, DDI with PPI and H2RAs)

A

CYP3A4 substrate, strong P-gp inhibitor

Avoid coadministration with PPIs and H2RAs (4 hours before, 10 hours after)

49
Q

Adagrasib AEs

A

Same as sotorasib, plus

Renal impairment
Edema
QT prolongation
Interstitial lung disease/pneumonitis

50
Q

Adagrasib pearls (3: substrate of what, inhibitor of what, pH-dependent absorption)

A

CYP3A4 substrate; inhibits its own metabolism at Css

Moderate CYP2B6, 2C9, P-gp inhibitor

No pH-dependent absorption

51
Q

VEGF inhibitors

A

Bevacizumab, ramucirumab

52
Q

AEs of VEGF inhibitors

A

Acute: HTN
Delayed: thromboembolic events, epistaxis, major bleeds, GI perforation, proteinuria, diarrhea (ramucirumab)

53
Q

VEGF inhibitor pearls (avoid in what?)

A

Avoid Avastin in patients with squamous histology

Avoid in patients with recent hemoptysis, on therapeutic anticoagulation for new onset VTE, recent surgical procedure

54
Q

Taxanes used in NSCLC

A

Paclitaxel, docetaxel

55
Q

Taxane AEs

A

Myelosuppression
Alopecia
Peripheral neuropathy (premedicate with 8mg dexa BID day before, day of, and day after infusion of docetaxel)
Mucositis
Diarrhea
N/V
Hypersensitivity reaction: premedicate with dexa, famotidine, diphenhydramine

56
Q

Taxane and CYP enzymes

A

CYP3A4 substrate; paclitaxel is a 2C8 substrate too

57
Q

Pemetrexed AEs

A

Myelosuppression
Erythematous/pruritic skin rash
Fatigue
Diarrhea
N/V

58
Q

Pemetrexed pearls (4: CrCl, NSAIDs, folic acid and B12, dexamethasone)

A

Avoid if CrCl <45ml/min

NSAIDs decrease clearance

Folic acid and B12 supplementation

Dexa 4mg BID day before, day of, and day after infusion decreases incidence of skin rash

59
Q

Etoposide AEs

A

Myelosuppression
N/V
Stomatitis
Alopecia

60
Q

Topotecan AEs

A

Myelosuppression (neutropenia)
N/V/D
Fatigue
Alopecia

61
Q

Lurbinectedin AEs

A

Fatigue
Hepatic enzyme elevations
Extravasation
Nausea
Myelosuppression
Increased SCr
Musculoskeletal pain

62
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: PD-L1 >=1-49%

A

Nivolumab and ipilimumab

Pembrolizumab

63
Q

PD-L1+ and Nonbiomarker Driven NSCLC treatment: nonsquamous and PD-L1 <1%

A

Carboplatin + paclitaxel + atezolizumab + bevacizumab

PHM 703- Oncology, Hematology (15 decks)

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