Lung Cancer

Question 1

Prevention and Screening of Lung Cancer :

1. How to prevent ?
2. WHo to screen ?
3. Stop screening when ?

Answer 1

1. No known effective method of chemoprevention.
   - smoking cessation !!!!
2. Adults aged 50-80 yrs, 20 pack year smoking hx and currently smoke or have quit within past 15 yrs
   –> screen for LC w/low dose computed tomography every year !
3. once a person has not smoked for 15 yrs or has a health prob that limits life expectancy or ability to have lung surgery

Question 2

Adjuvant Cytotoxic Chemotherapy :

1. When would you use Carboplatin over Cisplatin ?
2. Carboplatin/Cisplatin duo that is preferred for NON squmous?
3. Whats 2 ae’s of cisplatin that u might pick carboplatin over for ?
4. In which comorbidity would we prefer Carboplatin over cisplatin ?

Answer 2

1. In patients who have comorbidities or are unable to tolerate cisplatin
2. Pemetrexed
3. Ototoxic and Nephrotoxic ,
4. CHF. To prevent the nephrotoxicity of cisplatin, u would have to hydrate, which is bad for CHF patients

Question 3

For PDL1 TPS >= 50% : 1st line options

1. For Adenocarcinoma which regimen ?
2. For squamous, what drug would u not find ?

For PDL1 TPS >= 1-49% : 1st line options
3. For adenocarcinoma?

4. What ae’s for Carboplatin ?
5. WHat AE’s for Paclitaxel ?
6. If ur pt has uncontrolled diabetes with significant peripheral neuropathy what regimen would u avoid?

Answer 3

1. CArboplatin + Paclitaxel + Bevacizumab +Atezolizumab
   -CArbo/Cisplatin + PEMETREXED + Nivolumab + Iplimumab
2. Bevacizumab and Pemetrexed
3. Same as above
4. Myelosuppression
5. Peripheral neuropathy
6. Any regimen with paclitaxel

Question 4

When are PDL1 Inhibs NOT used or CI :
1. Active or previously documented ___
2. Current use of ? (3)
3. Presence of an oncogenic driver mutation such as?

Answer 4

1. AUtoimmune disorder
2. Immunosuppressants
   -Prednisone > 10mg/day
   -Mycophenolate mofetil
   -TNF alpha inhibs
3. EGFR, ALK, ROS, BRAF, NTRK

Question 5

Cisplatin Vs Carboplatin

1. Cisplatin main AE’s –> N, N and V, M, O, R,
2. Cisplatin is the preferred platinum when systemic therapy is used with ____
3. Carboplatin AE’s –> N, N/V , generaly less __ than cisplatin but more ____
   -Can cause __ and ___ toxicity but less than cisplatin
   -____ abnormalities
   -Dose is based on ?

Answer 5

1. Neurotoxic (periph neuropathy)
   NAUSEA AND VONITING (high)
   Myelosuppression
   OTOTOXICITY
   RENAL TOXICITY (nephrotoxic)
2. Curative intent
3. Neurotoxic (Periph neurop infrequent, more with pt’s > 65)
   -N/V moderate
   - Toxic, Myeloblative
   -renal, oto
   -Liver function
   -AUC

Question 6

Cisplatin Induced Nephrotoxicity :
1. Hydration regimen ?
2. WHats the UOP goal ?
3. Monitoring ?
4. Can also use ___ in addition to hydration

Answer 6

1. 1-2 L for 2 hr prior to and for 2hrs after administration
   (1L NS + 20 mEQ KCL + 2grams Magsulfate over 2hr prior to chemo and 1L NS + 10mEQ KCL to run for 2hrs after chemo)
2. UOP > 100 mL/hr
3. Serum electrolytes (mag and potass) , BUN/Scr
4. Mannitol

Question 7

What’s the calvert equation ?

Answer 7

Carboplatin Dose = Target AUC x (CrCL + 25)

Question 8

Anti-Folates : Pemetrexed
1. Toxicities?
2. Use with caution if CrCL < ?
3. Supportive care ? (3)

Answer 8

1. Myelosupp, rash, fatigue, stomatitis/pharyngitis, nausea (low emetic risk as single agent )
2. 45 mL/min
3. Folic acid 1mg daily (7 days prior to 1st dose of pemetrexed and for 21 days after last dose)

Vitamin B12 1000mcg IM q9weeks ( during week preceding first dose pemetrexed and every 3 cycles thereafter)

Dexamethasone 4mg PO BID (starting day before pemetrexed , day of, and day after)

Question 9

Bevacizumab (VEGF) :
1. Whats some AE’s? (5)
2. Whats dose limiting Ae’s?

Answer 9

1. HTN, poor wound healing, proteinuria, hemorrhage, arterial thrombosis
2. HTN and poor wound healing

Question 10

EGFR Inhibitors : Gefit, Erlot, Afat, Osimert

1. WHat are the class AE’s? (6)
2. Management of EGFRI Associated rash
   -How to prevent ?
   -How to treat?
   -Non pharm?

Answer 10

1. Rash!!!, diarrhea, hepatotoxicity, stomatitis, ILD (interstitial lung disease) , can also get paronychia
2. Prevent : Hydrocort 1% cream w/moisturizer and sunscreen BID and minocycline 100mg daily or doxy 100mg BID

TX : Steroid Cream Fluocinonide 0.05% cream to AA BID and Mino 100mgDAILY or Doxy 100mg BID

Non pharm : Cleansing w/mild soaps and BID moisturizing w/thick, emollient based creams
-Prevent skin dryness by avoiding prolonged hot showers, remaining well hydrated and using only products that are alcohol , fragrance and dye free

Question 11

ALK Inhibitors : Class AE’s? (5)

Crizotinib, Ceritinib, Brigatinib, Alectinib, Lorlatinib

ROS1 Inhibitors
1. Main AE for Crizotinib? (3)
2. Main AE for Entrectenib? (1)

Answer 11

N/V
Bradycardia
Hepatotoxicity !!!
ILD
Vision Disorders!

1. Vision, and hepatoxic , QT prolong , bradycardia, ILD
2. CONGESTIVE HF