Lung Cancer

Question 1

Describe the general treatment approach of solid tumors and the relative importance of treatments for cure.

Question 2

LIST common toxicities and MOA for cisplatin.

Answer 2

• 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)

Question 3

LIST common toxicities and MOA for carboplatin.

Answer 3

• Platinum agent; forms DNA crosslinks that impairs DNA replication, leading to cell death.
• More bone marrow suppression (thrombocytopenia)

Question 4

LIST common toxicities and MOA for paclitaxel.

Answer 4

• Taxane/plant alkaloid; binds to tubulin, promotes microtubule assembly, prevents disassembly (paclitaxel paralyzes)
• Hypersensitivity reactions (cremophor; pre-medication required = dexa, diphen, H2RA), peripheral neuropathy

Question 5

LIST common toxicities and MOA for bevacizumab.

Answer 5

• VEGF targeting agent; prevents from binding to receptor - works outside the cell
• Hypertension, proteinuria, impaired wound healing, bleeding, thromboembolic events

Question 6

LIST common toxicities and MOA for docetaxel.

Answer 6

• 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

Question 7

LIST common toxicities and MOA for pemetrexed.

Answer 7

• 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)

Question 8

LIST common toxicities and MOA for EGFR TKIs.

Answer 8

• 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)

Question 9

LIST common toxicities and MOA for etoposide.

Answer 9

• Topoisomerase II inhibitor; epipodophyllotoxin
• Hypotension (rate limiting), secondary leukemia (11q23/MLL gene mutations)

Question 10

LIST common toxicities and MOA for ALK TKIs.

Answer 10

• ALK inhibitor
• Bradycardia, pancreatitis, QT prolongation, ILD

Question 11

LIST common toxicities and MOA for immune checkpoint inhibitors.

Answer 11

• PD-1 monoclonal antibodies
• Immune mediated (liver, endocrine, GI, skin, cardiac), adrenal insufficiency, hypothyroidism

Question 12

Identify brand/generic name of osimertinib.

Answer 12

Tagrisso

Question 13

Identify brand/generic name of nivolumab.

Answer 13

Opdivo

Question 14

Identify brand/generic name of pembrolizumab.

Answer 14

Keytruda

Question 15

Identify brand/generic name of pemetrexed.

Answer 15

Alimta

Question 16

Compare the pathophysiology, natural disease course, and treatment of non-small cell lung cancer (NSCLC) with small cell lung cancer (SCLC).

Question 17

Differentiate the role of chemotherapy for NSCLC vs. SCLC.

Question 18

LIST the risk factors for lung cancer.

Question 19

Plan a supportive care regimen to prevent/limit toxicity for cisplatin.

Question 19

Plan a supportive care regimen to prevent/limit toxicity for carboplatin.

Question 20

Plan a supportive care regimen to prevent/limit toxicity for paclitaxel.

Question 21

Plan a supportive care regimen to prevent/limit toxicity for docetaxel.

Question 22

Plan a supportive care regimen to prevent/limit toxicity for gemcitabine.

Question 23

Plan a supportive care regimen to prevent/limit toxicity for pemetrexed.

Question 24

Plan a supportive care regimen to prevent/limit toxicity for etoposide.

Question 25

Plan a supportive care regimen to prevent/limit toxicity for osimertinib.

Question 26

Plan a supportive care regimen to prevent/limit toxicity for bevacizumab.

Question 27

Plan a supportive care regimen to prevent/limit toxicity for nivolumab.

Question 28

Plan a supportive care regimen to prevent/limit toxicity for pembrolizumab.

Question 29

Identify immune-related adverse events (irAEs) from PD-1 or PD-L1 inhibitors.

Question 30

Design a plan to treat irAEs.

Question 31

Describe the concept of “personalized medicine” as it relates to lung cancer treatment in essay form.

Question 32

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.