Lung Cancer Flashcards
What are the risk factors for lung cancer?
Tobacco smoking and exposure
Age: rare in less than 40 yo
Genetics
Occupational/ Environmental exposures
What are the genetic mutations responsible for lung cancer?
p53 KRAS EGFR MYC c-KIT
What are occupational/ environmental exposures?
Radiation therapy Second-hand smoke Asbetos Radon Metals
Smoking causes what type of lung cancer?
SCLC
The doubling time/growth rate is rapid in which type of lung cancer?
SCLC
What is the general treatment type for SCLC?
Chemotherapy
Which type of lung cancer is paraneoplastic syndromes common?
SCLC
What are the staging criteria for SCLC?
Limited
Extensive
What are paraneoplastic syndromes?
Appear unrelated to cancer but are sx of the cancer
What is the screening for lung cancer?
Evaluation of individual risk assessment
Low dose spinal CT in high risk patients who are potential candidates for treatment
What are considered high risk patients for lung cancer?
Age 55-74: smoking at least 30 packs/yr, or smoking cessation within 15 years
Age 50+: 20-29 pack/yr, with one additional RF
What are pulmonary and thoracic s/sx?
Cough Dyspnea Chest pain Sputum production Hemoptysis Pleural effusion Hoarseness Superior vena cava syndrome Dysphagia Wt loss
What are sx of metastatic involvement?
Neurologic: paralysis, neurologic deficits, spinal cord compression Bone pain Liver dysfunction Adrenal dysfunction Lymphadenopathy
What are paraneoplastic syndromes?
Hypercalcemia Cushing syndrome Vasopressin --> SIADH Immune mediated Eaton-Lambert syndrome
How do we diagnose lung cancer?
Hx, PE, Lab testing
PFT
Radiography
Biopsy
What type of biopsies are used to test for lung cancer?
TBNA Thoracentesis Mediastinoscopy VATS and open surgical biopsy EBUS - guided forceps biopsy EUS - guided biopsy
What is limited stage SCLC?
Lung cancer that can be safely treated with definitive radiation doses
What is extensive stage SCLC?
Stage IV
Tumor/nodal volume too large to fit in a tolerable radiation plan
What are poor prognostic factors for SCLC?
ECOG > 3
Wt loss
Markers associated with bulky disease
What is the goal of limited stage SCLC?
Cure
What is treatment for limited stage SCLC with good performance status?
Radiation concurrently w/chemotherapy
What is the treatment for limited stage SCLC with poor performance status?
Chemo +/- radiation
What is the goal of extensive stage SCLC?
Include palliation, prolong life (very rarely curable)
What is the treatment of extensive stage SCLC with good performance status?
Chemo +/- radiation to sx metastatic sites
What is the treatment of extensive stage SCLC with poor performance status?
Supportive care
When is prophylactic cranial irradiation used?
If complete/partial response attained
If still good performance status and minimal comorbidities
What are the preferred drugs of choice for SCLC?
Cisplatin and Etoposide (w/radiation)
Carboplatin and Etoposide
What do we do with the therapy if a patient with SCLC has a relapse w/in 6 months with ECOG 0-2?
+/- ipilimumab
Topotecan, Irinotecan, Temozolomide, Paclitaxel, CAV, gemxitibine, docetaxel, etopodisde, vinorelbine, nivolumab
What do we do if a patient has a relapse of SCLC after 6 months?
Retry original regimen
What are types of supportive care for SCLC?
Pain management N/V MGFs Radiation therapy toxicities Paraneoplastic syndrome tx
Which stages of NSCLC are resectable?
I, II, III
What are treatment options for stages I, I, and III NSCLC?
Srugery +/- adjuvant radiation (if positive margins)
Adjuvant chemotherapy/ chemoradiation
If the cancer is unresectable in stage IIB or IIIA, what are treatment options?
Chemoradiation
What are the drugs that are used in EGFR mutation positive NSCLC patients?
Erlotinib
Afatinib
Gefitinib
What are the drugs used in ALK mutation positive NSCLC patients?
Alectinib
Crizotinib
Ceritinib
What is the drug used for PD-L1 expression positive NSCLC patients?
Pembrolizumab
What drugs are used for adenocarcinoma with negative NSCLC mutations?
Doublet chemo +/- bevacizumab
What drugs are used for squamous cell NSCLC?
Doublet chemotherapy
What drugs are used with early stage adjuvant chemotherapy for NSCLC?
Cisplatin plus one of the following
Vinorelbine, etoposide, vinblastine, gemcitabine, paclitaxel, pemetrexed
Which histology is pemetrexed used with?
Non-squamous cell
Why would carboplatin be used in place of cisplatin for NSCLC?
Decrease toxicity
What is considered advanced/metastatic disease?
Stage IV or IIIB with pericardial effusions or supraclavicular lymph node involvement
If a patient has advanced metastatic NSCLC disease with an EGFR mutation, what medication can be initiated?
Erlotinib
Afatinib
Gefitinib
If a patient has advanced metastatic NSCLC disease with an ALK mutation, what medication can be initiated?
Alectinib
Crizotinib
Ceritinib
If a patient has advanced metastatic NSCLC disease with a PD-L1 expression, what medication can be initiated?
Pembrolizumab
If a patient has advanced metastatic NSCLC disease with no mutations (adenocarcinoma), what medication can be initiated?
Doublet chemotherapy +/- bevacizumab
If a patient has advanced metastatic NSCLC disease with squamous cell histology, what medication can be initiated?
Doublet chemotherapy
What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on
doublet + bevacizumab?
Bevacizumab
What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on cisplatin/pemetrexed?
Pemetrexed
What is the maintenance therapy for NSCLC advanced/metastatic disease if there is no disease progression and they were on Bevacizumab/pemetrexed with cisplatin or carboplatin?
Bevacizumab + pemetrexed
If the patient has advanced/metastatic NSCLC and their initial therapy was platinum based doublet, what drug can be used as a switch agent?
Pemetrexed
What drugs are affected by EGFR mutations?
Erlotinib
Afatinib
Gefitinib
What drugs are affected by KRAS mutations?
Erlotinib
Afatinib
What drugs are affected by EML4-ALK mutations?
Alectinib
Crizotinib
Ceritinib
