Lung Cancer Flashcards
how common is lung cancer
2nd most common cancer
how common is lung cancer death
number 1 most cancer deaths
5 year survival rate lung cancer
15-62%
what percent of lung cancers are from tobacco
85-90%
patho of lung cancer
epithelial cells are exposed to carcinogens and theres chronic inflammation
EGFR mutations predict resistance to what therapies
tyrosine kinase inhibitors
KRAS mutations predict resistance to what therapies
tyrosine kinase inhibitors
are EGFR mutations found in non smokers or smokers
non smokers
are KRAS mutations found in non-smokers or smokers
smokers
are ALK mutations found in smokers or nonsmokers
non-smokers
what are ALK mutations sensitive to
EGFR inhibs/chemo
is ROS-1 mutations in smoker or non smoker
non smoker
is BRAFV600 in smoker or non smoker
smoker
what mutations should we test for first line
BRAF
PD-L1 in metastatic
when is PD-L1 testing not reccomended
SCLC
percentages of histology lung cancer
adenocarcinoma 50%
squamous 30%
large cell 5%
small cell 15%
which type of carcinoma seen in non smokers
adenocarcinoma
which lung cancer has clear relationship to smoking
small cell lung cancer
which type of lung cancer has paraneoplastic syndrom
small cell
which lung cancer grows faster
small cell
SIADH seen with which cancer
small cell
what is SCLC sensitive to
chemo and radiation
NOT surgery
limited SCLC treatment
radiation + cisplatin(or carbo) +etoposide
what kind of radiation is reccommended in SCLC for prophylaxis
cranial radiation
treatment of SCLC extensive chemo
cisplatin/carboplatin
etoposide/ironotecan
+ atezolizumab or durvalumab
should SCLC extensive get radiation
no
when to do cranial radiation if symptomatic in brain (extensive)
before chemo
atezolizumab moa
PDL1 inhibitor
durvalumab moa
PD-L1 inhibitor
when to stop atezolizumab and durvalumab after chemo
keep it going, indefinite
cisplatin toxicities
N/V
nephrotoxicity (renal failure)
ototoxicity
neuropathy
pembrolizumab MOA
PD-1 inhibitor
if pt progresses or cant tolerate chemo whats an option for single agent therapy in SCLC metastatic
pembrolizumab
once we do radiation once can we do it again?
no, only once on brain
is NSCLC sensitive to chemo / radiation
moderate to radiation
low to chemo
what is the best option in NSCLC
surgery
neoadjuvant therapy for resectable NSCLC consists of what
nevolumab + platinum doublet
adjuvant chemo for non squamous NSCLC
cisplatin + pemetrexed
adjuvant chemo for NSCLC squamous
cisplatin + gemcitibine
cisplatin + docetaxel
adjuvant chemo for NSCLC squamous if no cisplatin
carboplatin + paclitaxel
carboplatin + gemcitibine
alectinib indication after chemo and length
ALK +
2 years
osimertinib indication after chemo and length
exon 19 deletion
3 years
atezolizumab indication and length
PD-L1 > 1%, no mutations
q2-4 weeks x 1 year
pembrolizumab indicatin and length
no mutations
q3-6 weeks x 1 year
unresectable NSCLC non squamous
platinum + pemetrexed
unresectable NSCLC squamous
platinum + taxane
immuno agents to give after chemo in unresectable NSCLC
duvalamab
osimertinib
single agent if cant tolerate chemo in NSCLC
pembrolizumab
NSCLC metastatic tx if T790M
osimertinib
NSCLC metastatic if BRAF mutation
dabrafinib + trametinib
side effects dabrafinib
skin cancer
fever
side effects trametinib
fevers, rash
visual changes
NSCLC metastatic KRAS G12C mutation
sotorasib
NSCLC metastatic non-squamous no mutation
carboplatin + pemetrexed + pembrolizumab
contraindications to immunotherapy
autoimmune diseases
NSCLC metastatic squamous if contraindication to immunotherapy
platinum doublet
carboplatin + taxane / gemcitibine
NSCLC metastatic squamous if no contraindication to immunotherapy
pembrolizumab
carboplatin
paclitaxel / Nab-paclitaxel
what can happen from immune mediated toxicity
pneumonitits
colitis
hepatitis
nephritis
endocrine
what labs should we get for pts on immunotherapy? (6)
CBC
CMC
TSH
free T4
amylase
lipase
who should be screened in lung cancer?
high risk
age 55-74
30 pack year history
still smoking or quit within past 15 years
good health and willing to have surgery if detected
what supplement can cause lung cancer
beta carotene
