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Medical Oncology SCE > Lung Cancer > Flashcards

Lung Cancer Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the relative risk reduction found in metanalyses of UK Lung screening?

A

20%

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2
Q

What is the most frequent gene aberration seen in SCLC?

A

TP53 (89%) and RB1 (64%).

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3
Q

Describe treatment of limited stage SCLC

A

Typically concurrent chemoRT with cisplatin and etoposide. If very early disease and surgery performed then 4 cycles of cisplatin/etoposide should be given adjuvantly.

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4
Q

What is the evidence for PCI in limited stage SCLC? What is the alternative?

A

Improves OS and reduces risk of brain metastases by 50%. Alternative is MRI surveillance every 3 months.

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5
Q

In CKD patients undergoing chemotherapy for extensive stage SCLC, what adjustments should be made.

A

Etoposide should be reduced. If CrCl 15-50ml/min give 75% dose.

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6
Q

When is adjuvant RT indicated in limited stage SCLC?

A

N2 or positive resection margins.

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7
Q

What is the overall survival benefit for the addition of atezolizumab in extensive stage SCLC?

A

mOS 12.3m vs 10.3m

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8
Q

When would thoracic consolidation RT be of benefit in extensive stage SCLC?

A

In patients with residual thoracic disease following completion of 6 cycles carbo/etop +- atezolizumab

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9
Q

What are the chemotherapy options for patients with platinum resistant disease in SCLC?

A

If relapsed within 3m of completion of chemotherapy can consider further chemotherapy with CAV (cyclophosphamide, doxorubicin and vincristine) or PO topotexan if felt unsuitable for CAV.

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10
Q

Name paraneoplastic syndromes associated with SCLC?

A

Hypercalcaemia, SIADH, Cushings, Lambert-Eaton syndrome and cerebellar degeneration.

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11
Q

Which antibodies may be associated with paraneoplastic cerebellar ataxia?

A

Anti-Yo and Anti-Hu.

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12
Q

Describe T staging for NSCLC

A

T1 <3cm, T2 3-5cm, T3 5-7cm, T4 >7cm

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13
Q

How are early stage Pancoast tumours treated?

A

Chemoradiotherapy followed by surgery

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14
Q

When should neoadjuvant treatment be offered in NSCLC?

A

In stage IIA, IIB,
IIIA or N2 IIIB NSCLC

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15
Q

Describe stage IIA disease in NSCLC

A

T2b, N0

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16
Q

Describe stage IIb disease in NSCLC

A

T1-2, N1 OR T3, N0

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17
Q

Describe stage IIIA disease in NSCLC

A

T1-2, N2 or T3-4 N1 or T4 N0

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18
Q

What neoadjuvant treatment should be offered in NSCLC?

A

Chemotherapy with nivolumab for 3 cycles

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19
Q

When should adjuvant chemotherapy be offered in NSCLC?

A

Node positive or tumour >4cm

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20
Q

When are you eligible for adjuvant osimertinib and what is the duration of treatment?

A

In EGFR exon 19 deletion or exon 21 substitution in stage IB-IIIA disease (with or without chemotherapy)

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21
Q

When are you eligible for atezolizumab adjuvantly?

A

PDL1 >50% following chemotherapy in stage IIB or IIIA or N2 only IIIB tumour.

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22
Q

When is durvulamab licensed in the adjuvant setting?

A

In unresectable stage III disease where there has been no progression following CRT and PDL1 >1%

23
Q

First line treatment of SqCLC with PDL1 >50% and no other targetable mutations?

A

Pembrolizumab, carboplatin and paclitaxel or pembrolizumab or atezolizumab monotherapy

24
Q

Second line treatment of SqCLC with PDL1 >50% and no other targetable mutations?

A

Doublet chemo when not used in first line or docetaxel

25
Q

First line treatment of SqCLC with PDL1 <50% and no other targetable mutations?

A

Carboplatin and vinorelbine or pembro, carboplatin and paclitaxel

25
Q
A
26
Q

Second line treatment of SqCLC with PDL1 <50% and no other targetable mutations?

A

Atezo (PDL1 0-100%), Nivo (PDL1 0-100%) or Pembro (PDL1 >1%) or docetaxel. Vice versa for third line.

27
Q

First line treatment of NSqCLC with PDL1 >50% and no other targetable mutations?

A

Carbo, pemetrexed and pembrolizumab (pemetrexed and pembro maintenance) or pembrolizumab or atezolizumab monotherapy.

28
Q

Second line treatment of NSqCLC with PDL1 >50% and no other targetable mutations?

A

Platinum doublet (plus pemetrexed maintenance) if not used in first line or docetaxel +- nintedinib.

29
Q

First line treatment of NSqCLC with PDL1 <50% and no other targetable mutations?

A

Carboplatin, pemetrexed +- pembrolizumab or Atezolizumab, bevacizumab, carboplatin and palcitaxel

30
Q

Second line treatment of NSqCLC with PDL1 <50% and no other targetable mutations?

A

Immunotherapy if not had in first line Atezo (PDL1 0-100%), Nivo (PDL1 0-100%) or Pembro (PDL1 >1%). Or Docetaxel +- nintedanib.

31
Q

In patients with high PDL1 expression when would you use chemotherapy alongside IO?

A

In non smokers

32
Q

Which targeted therapy (and in which line of treatment) would be used in a RET fusion NSCLC?

A

Selpercatinib in any line of treatment

33
Q

Which targeted therapy (and in which line of treatment) would be used in a NTRK fusion NSCLC?

A

Entrectinib or Larotrectinib in third or fourth line.

34
Q

Which targeted therapy (and in which line of treatment) would be used in a METex14 skipping mutated NSCLC?

A

Topotecan in any line of treatment

35
Q

Which targeted therapy (and in which line of treatment) would be used in BRAF V600E mutated NSCLC?

A

Dabrafenib/Trametinib in first line

36
Q

Which targeted therapy (and in which line of treatment) would be used in a ROS1 mutated NSCLC?

A

Crizotinib or entrectinib in the first line

37
Q

Which ROS1 targeted therapy has greater CNS activity?

A

Entrectinib

38
Q

Which EGFR mutation confers worse prognosis?

A

EGFR exon 21 (L858R)

39
Q

How common is EGFR mutation in NSCLC?

A

14-40%. More common in asian population.

40
Q

Which mutation is found in around 50% of EGFR mutant cancers on progression with first generation EGFRi and can be targeted with osimertinib?

A

Exon 20 T790M mutation

41
Q

How common are ALK mutation in NSCLC?

A

5%

42
Q

Which markers are suggestive of mesothelioma? As least two positive markers and two negative markers needed for diagnosis.

A

Positive: CK5/6, calretinin or Wilms tumours 1, D0240
Negative: TTF1, CEA, Ber-EP4

42
Q

Which ALKi can be used in first line

A

Brigatanib, ceritinib, alectinib and crizotinib.

43
Q

Is the loss of BRCA associated protein 1 (BAP1) more common in epithelioid or sarcomatoid mesothelioma?

A

Epithelioid

44
Q

What is first line in mesothelioma if unable to have immunotherapy? And what is the expected survival benefit?

A

Cis or carboplatin + pemetrexed (up to 6 cycles). Survival benefit of 3-4 months.

45
Q

What is the purpose of Vit B12 and folic acid supplementation with pemetrexed

A

Significantly reduces the risk of severe myelosuppression and mucositis.

46
Q

What RT regime might you consider for symptom control in haemoptysis?

A

17Gy in 2 fractions 1 weeks apart or 10 Gy single fraction

47
Q

Which ALKi most commonly causes visual disturbance?

A

Crizotinib

48
Q

If etoposide contraindicated in SCLC what is the best option to replace in a platinum based doublet?

A

Irinotecan

49
Q

Positive anti-Jo1 antibodies in the presence of muscle weakness are indicative of which paraneoplastic syndrome?

A

Dermatomyositis

50
Q

Which CPI can be used in second line for metastatic adenocarcinoma with PDL1 0%

A

Atezo

51
Q

What would you do in EGFR positive disease with CNS only progression?

A

Switch to osimertinib if using first generation TKI

Medical Oncology SCE (27 decks)

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