Lung Cancer Flashcards
Which type of lung cancer leads to a shorter life expectancy due to rapid tumor growth and metastasis? (NSC vs SC)
SCLC
What are common metastatic sites of lung cancer?
- Contralateral lung
- Lymph nodes
- Liver
- Adrenal glands
- Bone
- CNS*
What are unique symptoms of lung cancer?
- SVC syndrome
- Neurologic symptoms due to CNS metastases
- Paraneoplastic syndromes (SIADH, hypercalcemia)
How do you calculate pack years?
Years of smoking * Number of packs/day smoked
(1 pack = 20 cigarettes)
Who should we screen for long cancer?
- Adults 50-80 years
- Smokers who quit within the last 15 years AND have a 20+ pack-year smoking history
- Without disqualifying comorbidity that shortens life expectancy
How do we treat resectable stage 1 NSCLC?
Surgical resection
How do we treat unresectable stage 1 NSCLC?
RT
How do we treat resectable stage 2 NSCLC?
- Surgical resection +/- neoadjuvant
- Adjuvant therapy
How do we treat unresectable stage 2 NSCLC?
Chemo + RT
How do we treat resectable stage 3 NSCLC?
- Surgical resection + neoadjuvant therapy +/- RT
- Adjuvant therapy
How do we treat unresectable stage 1 NSCLC?
- Chemo + RT
- Durvalumab maintenance
What is the preferred platinum chemo regimen for non-squamous histology?
Cisplatin/pemetrexed
Which drug can only be used for non-squamous histology?
Pemetrexed
Which people are not candidates for cisplatin?
Poor performance status or significant comorbidities
Which consideration does the Calvert equation take into account while dosing carboplatin?
Renal function
Which specific ADE is more common in carboplatin than cisplatin?
Thrombocytopenia
What are side effects of platinum-based chemotherapy agents?
- Myelosuppression
- N/V
- Diarrhea/constipation
- Nephrotoxicity
- Ototoxicity
- Peripheral neuropathy
Which body weight should be used for obese patients?
AdjBW
What is the Calvert equation?
Total dose (mg) = Target AUC x (CrCl + 25)
How do you calculate the maximum carboplatin dose?
Target AUC x 150 mL/min
What are side effects of taxanes (docetaxel, paclitaxel) that we should tell patients about?
Alopecia and peripheral neuropathy
What is the maximum CrCl that should be used in the Calvert equation?
125 mL/min
What should we give to patients taking taxanes to prevent hypersensitivity reactions?
Dexamethasone, famotidine, Benadryl
Why do we give dexamethasone with pemetrexed?
To prevent skin rash
Which ADEs are unique to osimertinib compared to other EGFR inhibitors?
- QTc prolongation
- Mouth sores
- Fatigue
What sorts of dermatologic management should be used for patients on EGFR inhibitors?
- SPF 25 sunscreen
- Gentle skin care (avoid OTC acne products)
- Topical or systemic antibiotics/steroids
What should we do if a patient develops grade 3 rashes on an EGFR inhibitor?
- Delay treatment 1-2 weeks
- Consider dose reduction
- Continue rash management and add prednisone 0.5 mg/kg for 7 days
What are our preferred ALK inhibitors?
Brigatinib, Alectinib, Lorlatinib
What are the common side effects between the preferred ALK inhibitors?
- Muscle/joint pains
- Fatigue
Why does lorlatinib have multiple neurological side effects?
It has more CNS penetration (common site of lung cancer metastasis)
What are side effects of brigatinib?
- Diarrhea
- Fatigue
- Lung disease
- Myalgia
- HTN
What are side effects of alectinib?
- Constipation
- Fatigue
- Liver problems
- Peripheral edema
- Myalgia
- Anemia
What are side effects of lorlatinib?
- Fatigue
- Peripheral edema
- Mood problems
- Arthralgia
- Dyslipidemia
Which drug treats the exon 20 mutation?
Amivantamab
(EGFR/KRAS) mutations are more commonly associated with cigarette smoking
KRAS
Which drugs are approved for advanced or metastatic NSCLC with KRAS G12C mutation AFTER 1 prior therapy?
Sotorasib and Adagrasib
Which KRAS inhibitor requires an acidic environment?
Sotorasib
What are the monotherapy agents used for metastatic non-targetable NSCLC?
Pembrolizumab, Atezolizumab, Cemiplimab
What is second line treatment for metastatic non-targetable NSCLC if a checkpoint inhibitor has been tried?
Docetaxel + Ramucirumab
What is second line treatment for metastatic non-targetable NSCLC if a checkpoint inhibitor has not been tried?
- Pembrolizumab
- Nivolumab
- Atezolizumab
How should we treat grade 1 immunologic ADEs?
Continue
How should we treat grade 2 immunologic ADEs?
Hold immunotherapy and consider steroids
How should we treat grade 3 immunologic ADEs?
Hold immunotherapy and give prednisone 0.5-2 mg/kg/day or equivalent until resolution to grade 1, then taper for at least 1 month
How should we treat immunologic ADEs that are not resolved by steroids?
Mycophenolate, infliximab
What VEGF inhibitors can we use for NSCLC?
Bevacizumab, ramucirumab
How do we treat limited-stage SCLC?
Cisplatin/carboplatin + etoposide + concurrent RT
How do we treat extensive-stage SCLC?
Carboplatin + etoposide + atezolizumab/durvalumab
Cisplatin + etoposide + durvalumab
What are second line options for SCLC?
- Topotecan
- Lurbinectedin
- Clinical trial
What is the major side effect of etoposide, topotecan*, and lurbinectedin?
Myelosuppression
What are unique side effects of lurbinectedin?
Fatigue, hepatic enzyme elevations, extravasation, nausea (pretreat with zofran)
