Lung cancer

Question 1

What is SACT?

Answer 1

Systemic anti-cancer therapy

Question 2

What are the types of lung cancer?

Answer 2

Non-small cell lung carcinoma (75-85%)
- Adenocarcinoma (with subgroups eg EGFR
mutation)
- Squamous cell
- Large cell, adenosquamous, carcinomas,
carcinoid

Small cell lung carcinoma (15-20%)

Question 3

How is lung cancer managed based on the stage of disease?

Answer 3

Stage I: Surgery/Stereotactic
radiotherapy (SABR)

Stage II: Surgery (+/- SACT) or radical
radiotherapy (RT)

Stage III: Multimodality treatment

Stage IV: Palliative SACT (+/- RT)

Question 4

What is the response to chemotherapy of a lung cancer if it’s <4cm?

Answer 4

50%

Compared to 20% in>4cm

Question 5

What is the ECOG PS scale (0-5)?

Answer 5

Eastern Cooperative Oncology Group Performance status scale

0 - indicating fully active
1 - restricted in strenuous activity
2 - restricted in work activity but ambulatory and capable of self-care
3 - capable of limited self-care
4 - completely disabled
5 - dead

Question 6

How does tumour hypoxia affect treatment?

Answer 6

There are no blood vessels to deliver drug treatments and no oxygen to create free-radical with radiotherapy

A problem in larger tumours

Question 7

How does weight loss contribute to prognosis?

Answer 7

Worse prognosis because it’s a form of compensation and suggests there is microscopic disease

Question 8

What is stereostatic radiosurgery?

Answer 8

Uses many precisely focused radiation beams to treat tumours and other problems in the brain, neck, lungs, and liver

Question 9

What are some mutations seen in Non-small cell lung cancer?

Answer 9

EGFR, ALK,ROS-1, KRAS

Question 10

What is the class of drugs developed to treat EGFR mutations positive or ALK rearrangement positive lung cancer?

Answer 10

Tyrosine kinase inhibitors (TKI)

Question 11

What are the chemotherapy drugs used to block PD-1?

Answer 11

Pembrolizumab and Nivolumab

Programmed Cell Death Protein 1 (PD-1) plays a vital role in inhibiting immune responses and promoting self-tolerance through modulating the activity of T-cells, activating apoptosis of antigen-specific T cells and inhibiting apoptosis of regulatory T cell

So blocking it kills the cancer

Question 12

What are some drugs that block PDL-1?

Answer 12

• Atezolizumab (use with chemotherapy in extensive stage small cell lung cancer and in second-line non small cell lung cancer)
• Durvalumab (adjuvantly for 1 year duration after chemo-RT for stage 3 lung cancer)

PD-L1 acts as a pro-tumorigenic factor in cancer cells via binding to its receptors and activating proliferative and survival signalling pathways

So blocking it kills the cancer

Question 13

Which lifestyle choice causes often cancer mutations ?

Answer 13

Non smokers or light smokers