Lung Cancer Flashcards
What are risk factors for lung cancer?
- smoking
- radon/ionizing radiation
- asbestos
- occupational exposure
What is the primary risk factor for lung cancer?
smoking
What point does smoking drastically increase risk of cancer?
30 pack years
How is pack years measured?
cigarrettes/day and # of years smoking
How long does it take for risk to decrease after smoking cessation?
5 years
How is lung cancer prevented?
no effective prevention; smoking cessation if a smoker
What criteria must be met for annual screening?
55-80 y/o
AND
>/= 30 year smoking history
AND
currently smoking or quit <15 years ago
What type of screening should high risk individuals have?
low dose CT scans
What are the signs and symptoms of lung CA?
- cough
- hemoptysis
- dyspnea
- chest pain
- wheezing/ stridor
- hoarseness
- pleural/pericardial effusion
- weight loss
What are common sites of metastasis for lung cancer?
Lymph nodes
Liver
Brain
Bone
What is the most common type of NSCLC?
adenocarcinoma
What NSCLC is directly related to smoking?
squamous cell carcinoma
Which type of NSCLC is easier to do surgery on?
adenocarcinoma
What is treatment for stage 2 lung CA?
surgical resection
+ adjuvant chemotherapy
What agents are used for chemo in stage 2 lung cancer?
Cisplatin + Paclitaxel
What is treatment for stage 3A lung cancer?
chemo + surgery +/- XRT
What is the standard of chemotherapy care?
patient-based chemotherapy
What are options for chemo in stage 3A?
- cisplatin + vinorelbine
- cisplatin + gemcitabine
- cisplatin + docetaxel
What is treatment for stage 3B?
XRT + platin agent
What are options for chemo in stage 3B?
- cisplatin + etoposide
- vinblastine + Paclitaxrl
What 2 drug combination agents improve overall survival?
cisplatin or carboplatin + paclitaxel, docetaxel, gemcitabine, vinorelbine, irinotecan, etoposide, vinblastine, pemetrexed
What is the choice of chemotherapy dependent on in stage 4 lung?
- performance status
- presence/absence of driver mutations
What is considered first line when the tumor proportion score is >/= 5%?
Checkpoint inhibitors:
Pembrolizumab (KEYTRUDA)
What are side effects with Pembrolizumab (checkpoint inhibitors)?
“itis” due to enhanced T cell activity
What side effects are seen with Erlotinib (TARCEVA)
Rash (acne)
Diarrhea
What drug interactions are seen with EGFR inhibitors?
substrate CYP3A4
What are second line treatments for stage 4 NSCLC?
Nivolumab
Docetaxel
Erlotinib
What is the MOA of Nivolumab?
checkpoint inhibitor; inhibits PD-1 receptors
When is Pembrolizumab alone used in stage 4 NSCLC?
If PDL-1 >/= 5%
What role does surgery have in SCLC?
NO surgery
What is the treatment for limited stage SCLC?
XRT +. platinum doublet
When should a patient get Prophylactic Cranial Irradication?
If they had a complete response
What agents are used for SCLC chemo?
Cisplatin
Carboplatin
What side effect has an increased risk in carboplatin vs. cisplatin?
myelosuppression
What is treatment of extensive stage SCLC?
palliative chemo + platin based agent
What are the second line agents used in SSSCLC?
Topotecan
Irinotecan
taxane
Ifosfamide
What platin based combination is favored in extensive SCLC?
carboplatin + etoposide
