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Oncology Exam 3 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

*What is the #1 cause of lung cancer?

What are the #2 and #3 causes of lung cancer?

A

cigarette smoking!
Radon
Asbestos exposure

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2
Q

*Which type of cancers are most associated with smoking?

A

squamous cell

small cell

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3
Q

What is the average age of diagnosis of lung cancer?

A

70

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4
Q

T/F the risk of lung cancer decreases with age

A

false

Increases with age

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5
Q

There is an 80-90% reduction in risk for lung cancer after _____ years smoking cessation

A

15

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6
Q

*What is the only prevention for lung cancer?

A

Smoking cessation

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7
Q

*When is screening recommended for lung cancer and what?

A

annual low-dose CT imagining for HIGH risk patients

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8
Q

*Who are high risk patients for lung cancer?

A
  1. Age 55-77
  2. > /= 30 pack year history
  3. Smoking cessation < 15 years
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9
Q

S/S of lung cancer

A

chest pain, cough, hoarseness, weight loss, dyspnea

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10
Q

T/F most lung cancer is metastatic disease at diagnosis

A

True!
NSCLC 55%
SCLC 66%

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11
Q

Where does lung cancer like to travel? (4)

A
  1. brain
  2. bone
  3. liver
  4. adrenal glands
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12
Q

S/S of distant spread in lung cancer

A

Neurologic deficits
Bone pain
Jaundice

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13
Q

Common paraneoplastic syndromes in SCLC

A
  1. SIADH
  2. Cushing’s syndrome
  3. Eaton-Lambert Syndrome
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14
Q

Common paraneoplastic syndromes in NSCLC

A

Hypercalcemia

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15
Q

Other S/s of paraneoplastic syndromes in lung cancer

A

nail clubbing

hypercoagulability

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16
Q

What can be used for diagnosis in lung cancer surgical candidates?

A

Chest X ray
Chest CT
PET scan

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17
Q

Why is molecular testing done in lung cancer?

A

establish prognosis and treatment course

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18
Q

How do you confirm diagnosis in lung cancer?

A

tissue biopsy

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19
Q

*T/F SCLC is more common than NSCLC

A

false!

80-85% = NSCLC

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20
Q

*T/F SCLC and NSCLC are rapid growing

A

False!
SCLC = rapid
NSCLC = slow

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21
Q

*What are the 3 histologic subtypes of NSCLC?

A
  1. Adenocarcinoma (40%)
  2. Squamous cell (30%)
  3. Large cell (10%)
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22
Q

What are the 2 stages for SCLC?

A

Limited stage

Extensive stage

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23
Q

Limited stage in SCLC

A

tumor confined to 1 radiation field

stage I-III

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24
Q

Extensive stage in SCLC

A

Multiple lung nodules or distant spread

Stage IV

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25
Q

T/F surgery is the mainstay treatment in SCLC

A

False!

It is a fast growing tumor, so has limited role!

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26
Q

What is definitive treatment for limited stage SCLC?

A

radiation

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27
Q

Radiation in extensive stage SCLC

A

palliation of symptoms

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28
Q

T/F maintenance therapy of chemo is used in limited stage and not extensive stage

A

false!

only in extensive stage!

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29
Q

*Treatment for limited stage SCLC

A

cisplatin + etoposide + radiation

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30
Q

*Treatment for extensive stage SCLC

A

Same as limited + CPI

CPI = atezolizumab or durvalumab

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31
Q

*What 2 check point inhibitors are used in extensive stage SCLC?

A

atezolizumab

durvalumab

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32
Q

*Treatment for relapse <6 months in SCLC

A

Topotecan or clinical trial

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33
Q

*Treatment for relapse >6 months in SCLC

A

Use original regimen

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34
Q

Carboplatin dosing

A

use Calvert equation

based on AUC

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35
Q

Squamous cell NSCLC is more common in who?

A

Male, smokers

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36
Q

Adenocarcinoma NSCLC is more common in who?

A

Women, non-smokers

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37
Q

What is staging based on in NSCLC?

A

TNM system

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38
Q

Testing for KRAS is important for what in NSCLC?

A

predicts resistance

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39
Q

Testing for EGFR is important for what in NSCLC?

A

predicts response to EGFR TKIs

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40
Q

What is a common EGFR mutation in NSCLC?

A

T790M

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41
Q

ALK mutations in NSCLC are common in who?

A

97% adenocarcinoma
No/light smokers
Young age
Men

42
Q

ROS-1 mutations in NSCLC are common in who?

A

Adenocarcinoma
No/light smokers
Women

43
Q

What is the most common BRAF mutation in NSCLC?

A

V600E

44
Q

Who are BRAF mutations in NSCLC common in?

A

Current or former smokers

45
Q

T/F if you have a PD-L1 expression you typically have other rearrangements

A

False!
Typically do not
Same with BRAF!

46
Q

*T/F surgery is the initial treatment for resectable tumors in NSCLC

A

True

47
Q

Radiation in NSCLC

A

alternative to surgery or with chemo in stage III

48
Q

Chemotherapy in NSCLC

A

can be in all stages but mainly in II-IV

49
Q

*Non-squamous stage I-III treatment

A

cisplatin + pemetrexed

50
Q

*Squamous cell stage I-III treatment

A

cisplatin + gemcitabine

cisplatin + docetaxel

51
Q

*T/F pemetrexed can be used in any type of NSCLC

A

false!

NEVER in squamous cell

52
Q

*Supportive care with pemetrexed and why given

A

folic acid: GI and myelosuppression
vitamin B12: GI and myelosuppression
dexamethasone: rash

53
Q

Other ades of pemetrexed

A

nephrotoxicity

pulm toxicity

54
Q

*Stage IV NSCLC what is the mainstay treatment?

A

chemo

55
Q

*When deciding chemo in stage IV NSCLC what factors do you consider?

A
  1. performance status
  2. histology (squamous/non-squamous)
  3. molecular/biomarker testing
56
Q

*PS 3-4 treatment NSCLC

A

best supportive care

57
Q

PS 0-2 treatment

A

chemo
targeted therapy
immunotherapy

58
Q

*Treatment (-) or unknown mutational status for non-squamous PS 0-2

A

pemetrexed + platinum +/- pembrolizumab

*carboplatin/cisplatin

59
Q

(-) or unknown mutational status for non-squamous PS 0-2 maintenance therapy

A

Continuation maintenance

Switch maintenance: pemetrexed

60
Q

Treatment (-) or unknown mutational status for non-squamous/squamous progressive disease PS 0-2

A

*immune checkpoint inhibitors (no previous PD-1/PD-L1 inhibitor)

only exception: NO pemetrexed in squamous!

61
Q

*Bevacizumab indication in NSCLC

A

combo therapy for non-squamous NSCLC

62
Q

*When do you hold bevacizumab?

A

4 weeks prior to elective surgery

at least 4 weeks after

63
Q

BBW of bevacizumab

A

hemorrhage
GI perforation
wound healing complications

64
Q

Other ADEs of bevacizumab

A

HTN: hold in uncontrolled
Proteinuria: hold if >/= 2 g/24 hours

65
Q

*Treatment (-) or unknown mutational status for squamous PS 0-2

A

Platinum + 2nd agent

paclitaxel + carboplatin +/- pembrolizumb
carboplatin + gemcitabine (PS 2)

66
Q

*In squamous cell carcinoma what drugs have NO role? (3)

A

pemetrexed
bevacizumab
atezolizumab

67
Q

Negative or unknown mutational status for squamous PS 0-2 maintenance therapy

A 
continuation maintenance
switch maintenance (docetaxel)
68
Q

*Treatment EGFR+ NSCLC

A

Osimertinib

*squamous or non-squamous

69
Q

*Treatment EGFR+ NSCLC progression T790M+

A

Osimertinib

70
Q

*Treatment EGFR+ NSCLC progression T790M(-)

A

Switch TKI agent

71
Q

*Which EGFR inhibitors are used in NSCLC?

A

OAGED

Osimertinib
Afatinib
Geftinib
Erlotinib
Dacomitinib
72
Q

*T/F all of the EGFRs in NSCLC are oral

A

true

73
Q

Class reactions of EGFRs

A

rash

diarrhea

74
Q

Which EGR has risk of QT prolongation?

A

Osimertinib

75
Q

When would you reduce EGFR dose in rash?

A

severe!

76
Q

*Treatment ALK rearrangement NSCLC

A

Alectinib

*squamous or non-squamous

77
Q

T/F you can use standard acne therapies for EGFR associated rash

A

false!

May worsen rash

78
Q

*ALK inhibitors in NSCLC

A

ABCCL

Alectinib
Brigatinib
Certinib
Crizotinib
Loriatinib
79
Q

ALK inhibitor class ADEs

A 
hepatotoxicity (except briga)
pulmonary toxicity (rare)
80
Q

ADE of alectinib

A

photosensitivity

nephrotoxicity

81
Q

ADE of brigatinib

A

arthralgia/myalgia

hyperglycemia, pancreatitis (IGF-IR)

82
Q

ADE of certitinib

A

hyperglycemia, pancreatitis (IGF-IR)

83
Q

MOLA of ceritinib

A

inhibits ALK, ROS1, IGF-IR

84
Q

*Treatment ROS1 rearrangement + NSCLC

A

Crizotinib
Entrectinib
*squamous or non-squamous

85
Q

*Treatment BRAF V600E+ NSCLC

A

Dabrafenib + trametinib

86
Q

What type of drug is trametinib?

A

MEK inhibitor

87
Q

*ADE of trametinib

A

retinal detachment

retinal vein occlusion

88
Q

ADE of dabrafenib

A

fever

89
Q

*Treatment PD-L1+ non-squamous NSCLC

PD-L1 >50%

A

pembrolizumb

90
Q

*Treatment PD-L1+ non-squamous NSCLC

PD-L1 <50%

A

platinum + pemetrexed + pembrolizumab

*cis/carb

91
Q

*Treatment PD-L1+ squamous NSCLC

PD-L1 >50%

A

pembrolizumab

92
Q

*Treatment PD-L1+ squamous NSCLC

PD-L1 <50%

A

carboplatin + paclitaxel + pembrolizumab

93
Q

T/F chemotherapy ADEs are usually acute onset and immunotherapy typically delayed onset

A

true!

94
Q

ADE of immunotherapy

A

inflammatory or autoimmune effects

*any organ system involved

95
Q

Common ADE of immunotherapy

A

dermatitis
colitis
endocrine toxicities
hepatitis

96
Q

Life threatening ADE of immunotherapy

A

Neurologic effects
Cardiac toxicity
Pneumonitis
Colitis

97
Q

Grade I ADE with immunotherapy tx

A

continue ICI

98
Q

Grade II ADE with immunotherapy tx

A

hold ICI

resume at grade I

99
Q

Grade III ADE with immunotherapy tx

A

Hold ICI

High dose steroids

100
Q

Grade IV ADE with immunotherapy tx

A

Permanently discontinue ICI

High dose steroids

101
Q

*High dose steroids for immunotherapy ADEs

A

prednisone/methylpred 1-2 mg/kg/day

taper over 4-6 weeks

Oncology Exam 3 (6 decks)

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