Lung cancer

Question 1

Why did lung cancer have so poor prognosis?

Answer 1

• late stage at time of diagnosis

- no effective therapy for late stage

Question 2

How much does low-dose computed tomography screening lower lung cancer for high risk individuals? Is it definitive?

Answer 2

• 20% reduction in lung cancer mortality
• false positive rates
• > 90%, need to find “adjunct” biomarker

Question 3

Name four types of lung cancer

Answer 3

Squamous carcinoma 30%
Adenocarcinoma 40%
Small cell 15%
Large cell and others 15%

Question 4

Describe the mode of action of epidermal growth factor receptor (EGFR)? What cancer is it used to treat?

Answer 4

• one part in the cell, in the cell membrane, and in the cell
• can attack outside the cell portion with an antibody
• inner part can be attacked with a tyrosine kinase inhibitor (TKI) (small therapeutic molecule)
• lung cancer (EGFR drives lung cancer when that is the mutation present)

Question 5

Describe anaplastic lymphoma kinase (ALK) in lung cancer.

Answer 5

• translocation of ALK triggers cancer process

- determined by FISH

Question 6

What mechanisms do tumors use to escape the immune system?

Answer 6

• T cell can be inhibited by blocking antibodies presented by MHC on antigen-presenting cells
• cancer cells activate Programmed Cell Receptor PD-1 (inhibitor), suppressing T-cell function

Question 7

What are the resistant mechanisms to targeted therapies?

Answer 7

Primary resistance - already in the tumor from the start

Acquired resistance - developed during therapy (new drugs being developed to target these mechanisms)

Question 8

What does Osimertinib treat?

Answer 8

• third generation epidermal growth factor receptor tyrosine kinase inhibitor
• treats acquired resistance for patients with specific acquired resistance mutation

Question 9

How can PD-L1 heterogeneity influence treatment and diagnosis?

Answer 9

• then PD-1 inhibitor would only treat those cancer cells with PD-L1
• could cause a sampling error during biopsy