Lung Cancer Flashcards
What is important to know about the cases and the deaths related to Lung Cancer?
- 2nd most common
- MOST common cause of death
What is the main risk factor that affects Lung Cancer?
- SMOKING: can be basically preventable
- 85-90% of Lung Cancer is from Smoking
What are some of the other risk factors for Lung Cancer?
- RISK decrease after smoking cessation
- Heavy Metals
-?
What is the etiology of Lung Cancer?
- The Chronic exposure of carcinogens causing inflammation causing genetic changes = carcinogenesis
What are some of the mutations that are associated with Lung Cancer?
- EGFR [10-15%; common in AA & less in Asian; T790M]
- K-RAS [10-30% shorter survival; SMOKERS]
- ALK [4-8%; no/light smokers; young]
- ROS-1 [1%; never smoked]
- BRAF [1-2%; test in 1st line metastatic NSCLC]
- PD-L1 [early stage & metastatic]
What are the two histologic classifications for Lung Cancer?
- NSCLC: adenocarcinoma [50% & non-smoker], Squamous [30%], Large Cell [5%]
- SCLC: Small Cell [15% & Smokers]
What are some of the main differences between NSCLC & SCLC in Lung Cancer?
- SCLC: Smoking, Rapid Growth, HIGHLY sensitive to radiation & chemo
- NSCLC: Slow growth MOD sensitive to radiation, Slight sensitive to chemo
What are the two stages in SCLC?
- Limited & Extensive
Within SCLC, is surgery generally an option?
- NO; Radation and Chemo is
What is important to know about Limited Stage SCLC?
- CUREATIVE intent
- Survival ~12w
- Combined Modailty: Rads + Chemo
- NEED prophylactic cranial Rads
What are some of the regimens that are used for Limited Stage SCLC?
- EP: Cisplatin + Etoposide
- EC: Carboplatin + Etoposide
[Cisplatin < Carboplatin]
What is important to know about Extensive Stage in SCLC?
- RARELY CURABLE
- Survival ~6w
- Platinum Chemo WITHOUT Rads
What are some of the chemos that are used in Extensive Stage SCLC?
- Cisplatin or Carboplatin x4
[Etoposide or Irinotecan]
Should brain radiation by used in Extensive Stage SCLC?
- Yes, if metastases
- Symptomatic = Rads before Chemo
- Asymptomatic = Rads after Chemo
What are some of the Immunotherapies that can be used in Extensive Stage SCLC?
- Atezolizumab + Carboplatin + Etoposide [IMpower133 trail]
- Durvalumab + Carboplatin + Etoposide [CASPIAN trial]
- Durvalumab + Cisplatin + Etoposide
What are some of the complications of therapy for SCLC?
- Platinum drugs = Nephrotoxicity & Neurotoxicity
- Rads = Fatigue, Cardio issues
What is important to know about PD-1 Inhibitors in SCLC?
- Pembrolizumab: for patients that have progressed on or after platinum regardless of status
In Limited or Extensive SCLC, should radiation be give concurrently with chemo?
- Limited: yes; given with cisplatin
- Extensive: ?
What is important to know about Immunotherapy Extensive Stage SCLC?
- BOTH of the immunotherapies will be used as maintenacne after the chemo cycles
Within NSCLC, what are some of the important treatment stratedges to use?
- Surgery = MOST EFFICACIOUS
- Rads = when surgery not able
What are the three types of NSCLC treatment options?
- Resectable, Unresectable, Metastatic
What is the flow for Resectable NSCLC?
- Resectable [yes or no]
- Neoadjuvant
- Surgery
What is the neoadjuvant therapy that is used in Resectable NSCLC?
- Nivolumab + Platinum Doublet
When should Chemotherapy be used in NSCLC?
- Adjuvant [after surgery & Chemo] = standard of care
- NEED to know if squamous or non-squamous
For NON-SQUAMOUS, what is the preferred treatment for Adjuvant Resectable NSCLC?
- Cisplatin + Pemetrexed
For SQUAMOUS, what is the preferred treatment for Adjuvant Resectable NSCLC?
- Cisplatin + Gemsitabine
- Cisplatin + Docetaxel
For both of the Adjuvant [squamous or non-squamous], if cisplatin is not tolerated what should be used?
- Carboplatin [less toxicities]
WHat are some of the other adjuvant NSCLC therapies that can be used?
- Osimertinib [EGFR mutations]
- Atezolizumab [PD-L1] & Pembromlizumab [PD-1]
What is the flow for Unresectable NSCLC?
- Chemo & Rads
For NON-SQUAMOUS, what is the preferred treatment for Unresectable NSCLC?
- Same as Resectable
- Cisplatin [or Carboplatin] + Pemetrexed
For SQUAMOUS, what is the preferred treatment for Unresectable NSCLC?
- Paclitaxel + Carboplatin?
- Cisplatin + Etoposide?
What is the Immunotherapy that can be used for Maintenance in Unresectable NSCLC?
- Durvalumab: APPROVED for unresectable, stage III that has NOT progressed [1y]
When should Pembrolizumab be used in Unresectable NSCLC?
- Stage III –> when there is a lot of comorbidities & are not cadidates for surgery or chemo
For treatment of Metastatic NSCLC, what are some things that we want to look for?
- if there is a target or no target [mutations in genes]
What is the targeted therapy for EGFR mutations in Metastatic NSCLC?
- Exon 19 deletion & Exon 21 substitution
- Osimertinib [T790M]
What is the targeted therapy for BRAF mutations in Metastatic NSCLC?
- BRAF V600 mutation
- Dabrafinib + Trametinib [BRAF + MEK]
What is important to know about using Dabrafinib in general?
- Could causes secondary cancers [skin]
What is the targeted therapy mutation for K-RAS G12C mutations in Metastatic NSCLC?
- More associated with smoking
- Sotorasib
When there is NO MUTATION in Metastatic Disease, what is the goal of treatment?
- Check PD-L1 status [>1% = Pembrolizumab]
For NON-SQUAMOUS, what is the treatment of Metastatic NSCLC?
- Negative Mutation NSCLC
- Carboplatin + Pemetrexed + Pembrolizumab
For SQUAMOUS, what is the treatment of Metastatic NSCLC?
- Pembrolizumab + Carboplatin + Paclitaxel [or Gemcitabine or Docetaxel]
EXAMPLE: What would be the treatment regimen for someone that has LIMITED SCLC?
- Cisplatin + Etoposide WITH Rads
EXAMPLE: What would be the treatment regimen for someone that has EXTENSIVE SCLC?
- Cisplatin + Etoposide + Atezoliumab
- Add Immunotherapy WITHOUT Rads
EXAMPLE: What is the preferred regimen for someone with STAGE II NSCLC without any mutations?
- Neoadjuvant –> surgery
EXAMPLE: What is the treatment regimen for someone that has been newly diagnosed with Metastatic NSCLC with NO mutations?
- Squamous: Pembrolizumab + Carboplatin + Paclitaxel
- Non-Squmous: Pembrolizumab + Carboplatin + Pemetrexed
