Lung Cancer Flashcards
Describe the general treatment approach of solid tumors and the relative importance of treatments for cure.
LIST common toxicities and MOA for cisplatin.
- Platinum agent; forms DNA crosslinks that impairs DNA replication, leading to cell death.
- N/V, nephrotoxicity (hypokalemia, hypomagnesemia), ototoxicity, neuropathy, and gonadal toxicity (risk of infertility)
LIST common toxicities and MOA for carboplatin.
- Platinum agent; forms DNA crosslinks that impairs DNA replication, leading to cell death.
- More bone marrow suppression (thrombocytopenia)
LIST common toxicities and MOA for paclitaxel.
- Taxane/plant alkaloid; binds to tubulin, promotes microtubule assembly, prevents disassembly (paclitaxel paralyzes)
- Hypersensitivity reactions (cremophor; pre-medication required = dexa, diphen, H2RA), peripheral neuropathy
LIST common toxicities and MOA for bevacizumab.
- VEGF targeting agent; prevents from binding to receptor - works outside the cell
- Hypertension, proteinuria, impaired wound healing, bleeding, thromboembolic events
LIST common toxicities and MOA for docetaxel.
- Taxane/plant alkaloid; binds to tubulin, promotes microtubule assembly, prevents disassembly
- Hypersensitivity reactions (less common than paclitaxel), edema (requires premedication of dexa), peripheral neuropathy, greater myelosuppression than paclitaxel
LIST common toxicities and MOA for pemetrexed.
- Anti-folate; inhibits multiple enzymes in the folate pathway (DHFR, TS, GARFT, AICARFT)
- Requires premedication: folic acid 400 mcg to 1000 mcg daily, vitamin B12 1000 mcg IM q9w (both are given to reduce myelotoxicity; begin 1 week before initiation), dexamethasone 4 mg PO BID x 3 days beginning the day before treatment (reduces cutaneous reactions)
LIST common toxicities and MOA for EGFR TKIs.
- EGFR inhibitors; response best in tumors with activating EGFR mutations
- Acne-like rash, diarrhea, interstitial lung disease (besides lapatinib - targets HER2 as well, only diarrhea no rash, decreases LVEF no ILD)
LIST common toxicities and MOA for etoposide.
- Topoisomerase II inhibitor; epipodophyllotoxin
- Hypotension (rate limiting), secondary leukemia (11q23/MLL gene mutations)
LIST common toxicities and MOA for ALK TKIs.
- ALK inhibitor
- Bradycardia, pancreatitis, QT prolongation, ILD
LIST common toxicities and MOA for immune checkpoint inhibitors.
- PD-1 monoclonal antibodies
- Immune mediated (liver, endocrine, GI, skin, cardiac), adrenal insufficiency, hypothyroidism
Identify brand/generic name of osimertinib.
Tagrisso
Identify brand/generic name of nivolumab.
Opdivo
Identify brand/generic name of pembrolizumab.
Keytruda
Identify brand/generic name of pemetrexed.
Alimta
Compare the pathophysiology, natural disease course, and treatment of non-small cell lung cancer (NSCLC) with small cell lung cancer (SCLC).
Differentiate the role of chemotherapy for NSCLC vs. SCLC.
LIST the risk factors for lung cancer.
Plan a supportive care regimen to prevent/limit toxicity for cisplatin.
Plan a supportive care regimen to prevent/limit toxicity for carboplatin.
Plan a supportive care regimen to prevent/limit toxicity for paclitaxel.
Plan a supportive care regimen to prevent/limit toxicity for docetaxel.
Plan a supportive care regimen to prevent/limit toxicity for gemcitabine.
Plan a supportive care regimen to prevent/limit toxicity for pemetrexed.
Plan a supportive care regimen to prevent/limit toxicity for etoposide.
Plan a supportive care regimen to prevent/limit toxicity for osimertinib.
Plan a supportive care regimen to prevent/limit toxicity for bevacizumab.
Plan a supportive care regimen to prevent/limit toxicity for nivolumab.
Plan a supportive care regimen to prevent/limit toxicity for pembrolizumab.
Identify immune-related adverse events (irAEs) from PD-1 or PD-L1 inhibitors.
Design a plan to treat irAEs.
Describe the concept of “personalized medicine” as it relates to lung cancer treatment in essay form.
Select systemic cancer treatment (i.e. chemo, TKIs, etc.) that are appropriate for 1st line treatment of lung cancer using the tenets of personalized medicine and medication safety.
