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PHRM 864 Exam 2 > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

Epidemiology

A

1 killer in both men and women

2nd most common cancer in men and women

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2
Q

History of disease

A

Metastasis: BRAIN, bone, liver, lymph nodes, adrenal glands

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3
Q

Risk factors

A

Tobacco (85-90% of lung cancers)
-Risk decreases with smoking cessation but not to baseline

Radiation

Occupational/environmental exposure to asbestos

Heavy metals, radon, aromatic hydrocarbons

Genetics

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4
Q

Pathophysiology

A

Chronic exposure of epithelial cells to carcinogens results in chronic inflammation that can induce genetic and cytologic changes

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5
Q

Signs/symptoms

A

Local: cough, hemoptysis, dyspnea, rust-colored sputum, wheezing/stridor

Metastasis: bone pain, neurologic deficits, spinal cord compression, liver

Paraneoplastic:
SCLC: Cushing’s, SIADH, Myasthenic syndrome
NSCLC: hypercalcemia
Both: clubbing, edema, hyper-coagulability

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6
Q

Presentation

A

SCLC–> 67% present with metastases
NSCLC–>50% present with metastases

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7
Q

Mutations

A

EGFR–> sensitivity to TKI
-More common in females, Asians, and non-smokers

KRAS–> resistance to TKI
-Exclusive to smokers

ALK: more common in younger, andenocarinoma, and no/light smokers

ROS-1: more common in younger, adenocarcinoma, and no/light smokers

BRAF V600E: exclusive to current or former smokers

PDL-1: less common with EGFR, ALK, ROS-1

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8
Q

Screening

A

Spiral CT scan–> high risk only

55-74, 30-year pack history of smoking, current smoker or quit in past 15 years, good health, and willing to have curative lung surgery

False positives, multiple radiologists

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9
Q

Prevention

A

Smoking cessation

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10
Q

SCLC

A

Related to smoking
Rapid cell growth fraction
Paraneoplastic syndromes common
Treatment: chemo and radiation

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11
Q

NSCLC

A

Adenocarcinoma: common in non-smokers, located peripherally to lung

Squamous: related to smoking, located centrally in lung

Large cell: located peripherally to lung

Non-squamous

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12
Q

Staging (SCLC)

A

Limited–>tumor is confined to hemithorax and is contained in radiation port

Extensive–>tumor is not confined to hemithorax and not contained in radiation port (both lungs)

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13
Q

Limited stage

A

Highly sensitive to radiation and chemo

Without therapy:
Survival with limited: 12 weeks
Survival with extensive: 6 weeks
NO MAINTENANCE CHEMO OR SURGERY

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14
Q

Extensive stage

A

NO RADIATION

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15
Q

SCLC Limited stage treatment

A

Radiation + combination chemotherapy

EC: Cisplatin/Carboplatin + Etoposide every 21 days for 4-6 cycles

Radiation is daily (Mon-Fri) for 6-7 weeks

Prophylactic cranial radiation

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16
Q

SCLC Extensive stage treatment

A

Combination chemotherapy

Carboplatin + Etoposide + Atezolizumab every 21 x 4 cycles
Carboplatin + Etoposide + Durvalumab every 21 days x 4 cycles

Prophylactic cranial radiation:
If symptomatic: whole brain radiation prior to chemo
If asymptomatic: whole brain radiation after chemo

Maintenance chemo: Atezolizumab or Durvalumab until patient progresses or toxicities

If patient has progressed–> Pembrolizumab regardless of PDL-1 status

17
Q

NSCLC

A

Surgery is the most efficacious treatment of NSCLC

Radiation may be used in early-stage when surgery is not able

18
Q

NSCLC treatment (resectable)

A

Neoadjuvant chemo–> tumor > 4 cm or lymph node positive
-Platinum doublet + nivolumab x 3-4 cycles

Surgery

Adjuvant chemo
Non-squamous: Cisplatin + Pemetrexed every 21 days x 4 cycles
Squamous: Cisplatin + Gemcitabine every 21 days x 4 cycles
Cisplatin + Docetaxel every 21 days x 4 cycles

Targeted therapies after chemo
Early stage + ALK: Alectinib x 24 hours
Early stage + EGFR: Osimertinib x 3 years
Early stage + High risk + no mutation + PDL1 > 1%: Atezolizumab or Pembrolizumab

19
Q

NSCLC treatment (unresectable)

A

Radiation
Chemotherapy

Non-squamous
Cisplatin + Pemetrexed every 21 days x 3
Carboplatin + Pemetrexed every 21 days x 4

Squamous
Cisplatin + Etoposide
Carboplatin + Pacletaxel

Targeted therapies after chemo
Durvalumab x 1 year
Osimertinib until disease progression
If unable for surgery, chemo, or radiation
PDL1 > 1%–> pembrolizumab

20
Q

Adenocarcinoma (metastatic) NO MUTATION

A

Check PDL1 status
> 1-49%
1st line: Pembrolizumab +/- chemo

> 50%
1st line: Pembrolizumab +/- chemo
Atezolizumab
Cemiplimab +/- chemo

Negative:
1st line: Pembrolizumab/Atezolizumab + chemo

Chemo: Carboplatin + Pemetrexed

21
Q

Adenocarcinoma (metastatic) MUTATION

A

EGFR (exon 19 deletion or exon 21 sub)
Osimertinib

BRAF
Dabrafenib + Treametinib

KRAS G12C
Sotorasib

22
Q

Squamous

A

Check PDL-1 Status + Performance status

If not contraindications to immunotherapy
Pembrolizumab +/- chemo x 4 cycles

If contraindication to immunotherapy
Carboplatin + Paclitaxel/Docetaxel/Gemcitabine x cycles

PHRM 864 Exam 2 (17 decks)

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