Lung Cancer Flashcards
What is the screening guideline for lung cancer depending on the smoking history?
This is indicated for patients aged 50-80 years of age who have a 20 pack year smoking history and currently smoke or quit smoking within 15 years ago. They need yearly CT scans.
When giving Pembro or Atezolizumab in the adjuvant setting for early stage lung cancer which one is assoc with a larger survival benefit?
Atezolizumab, but you can still offer them Pembro.
What neoadjuvant regimens can be given for early stage lung cancer and what stages is this indicated for?
Nivolumab w Cisplatin w/Carbo/Paclitaxel (any histology), or Pemetrexed (non-squamous), or Gemcitabine (squamous), or Paclitaxel (any histology). You consider this treatment for tumors 4cm or more and/or N+ dx Stage IIA or higher.
For those that you want to give Nivolumab and chemo to in the the neoadjuvant setting what if they can’t tolerate Cisplatin what can you do?
Carboplatin/Gemcitabine (squamous) or you can do Carboplatin/Pemetrexed (non-squamous)
What are the regimens for neoadjuvant/adjuvant chemo/Pembro immunotherapy and what stages are this indicated for?
Here you give Pembro with chemo and then after surgery you give Pembro alone for a year. Pembro w/Cisplatin/Gemcitabine (squamous) or Pembro w/Cisplatin/Pemetrexed (non-squamous). Stages IIB-IIIB. Benefit is for those with CPS of 1 or higher
What are the indications to give adjuvant chemo for early stage NSCLC?
Stage IIA-T2bN0
T2b lesion is 4-5cm
Stage IIB-T1a-c,N1 T2a-2b,N1 T3,N0
Stage IIA-w/high risk features such as poorly diff, vascular invasion, wedge resection, visceral pleura dx, unknown lymph nodes
Stages IIB-IIIA
What ALK inhibitor is approved for early stage NSCLC in the adjuvant setting and for what stages?
Alectinib for stages II-IIIB
When is adjuvant Atezolizumab indicated in early stage NSCLC?
High risk Stage IIA or stages IIB-IIIB with CPS of 1 or higher and no ALK or EGFR mutation
When is adjuvant Osimertinib indicated for NSCLC?
For stages IB-IIIB after adjuvant chemo or after surgery if adjuvant chemo is not indicated. You give for a total of 3 years.
This is a freebie, but remember that Durvalumab can be added to chemo before surgery and then Durvalumab for a year after for Stage IIB-IIIB
What are the different ways you can get Stage IIB disease? You will use this flash card to help you remember the stage for adjuvant chemo based off the T/N stage only
T1abc-T2a,N1
T3,N0
T2b,N1
T1: less than 3cm
T2: 3-5 cm
T3: 5-7cm
N1: peribronchial and/or ipsilateral hilar and intrapulmonary
N2: ipsilateral subcarinal and mediastinal
Adjuvant chemotherapy is indicated for what stages?
Stage IIA w/high risk features
Stages IIB-IIIA
For Stage IIIB disease that is treated with chemo/RT what are the adjuvant tx options?
Durvalumab or Osimertinib if EGFR mutation is present.
What EGFR inhibitors are approved for metastatic NSCLC that has a EGFR exon 19 mutation or 21 L858R mutation? Focus on the preferred options
Osimertinib (preferred)
Other options: Osimertinib w/Cisplatin/Carboplatin and Pemetrexed (Cat 1) or Amivantamab+Lazertinib (Cat 1).
What is the preferred option for EGFR exon 20 mutation for metastatic NSCLC?
Amivantamab w/Carboplatin and Pemetrexed (non-squamous only). Or you can consider other typical regimens for Squamous/Adenocarcinoma
What are the preferred options for EGFR S7681, L861Q, G719X mutation in metastatic NSCLC?
Preferred options are Osimertinib and Afatinib. You can consider Erlotinib, Gefitinib, or Dacomitinib.
What are the Cat 1 recs for ALK mutation metastatic NSCLC?
Alectinib, Brigatinib, Lorlatinib. Lorlatinib and Alectinib are the newest ones that work the best.