Lung Cancer Flashcards
1
Q
Local Signs/Symptoms
A
- Cough
- Hemoptysis
- Wheezing
- Fever
- Dyspnea
2
Q
Metastases Signs/Symptoms
A
- Weight loss
- Bone pain
- Fatigue
- Neurologic symptoms
3
Q
Prevention
A
- Preferred over screening
- Smoking cessation - decreases secondary primary cancer
- Non-smokers have better tolerance and response to treatment
4
Q
Low Risk + Screening
A
- <50 and or <20 pack-year history of smoking
- No screening recommended
5
Q
Moderate Risk + Screening
A
- > = 50 and >= 20 pack-year history of smoking
- Second-hand smoke exposure with no additional risk factors
- No screening recommended
6
Q
High Risk + Screening
A
- 55-74 and >= 30 pack-year history of smoking and smoking cessation <15 years ago
- > =50 and >= 20 pack-year history of smoking and additional risk factors that increase risk of lung cancer
- Annual low-dose CT recommended
7
Q
Limited vs Extensive Stage
A
- Limited Stage - Stages I-III of SCLC
- Extensive Stage - Stage IV SCLC
8
Q
SCLC Treatment
A
- Sensitive to chemo + RT
- Systemic chemotherapy is backbone
- Differs based on limited or extensive stage
9
Q
Limited Stage Treatment
A
- Surgery - rare
- Lobectomy is preferred
- Chemo + RT q28D for 4 cycles
- Prophylactic cranial irradiation (PCI)
10
Q
Extensive Stage Treatment
A
- Chemo
- Consider PCI or MRI brain surveillance
11
Q
Relapsed/Refractory SCLC Treatments
A
- > 6 mo after treatment - repeat initial regimen
- =< 6 mo after treatment - single agent regimen
12
Q
Single Agent Options
A
- Lurbinectedin
- Docetaxel
- Gemcitabine
- Etoposide PO
- Irinotecan
- Paclitaxel
- Temozolomide
- Topotecan (PO or IV)
- Vinorelbine
13
Q
Platinums
A
- Cisplatin- give with Amifostine to prevent nephrotoxicity
- Carboplatin - Dose = TargetAUC * (GFR+25), GFR capped at 125
14
Q
Platinum AEs
A
- Hypersensitivity rxn
- Nephrotoxicity
- Myelosuppression
- N/V - cisplatin causes acute and delayed
- Neuropathy
15
Q
Topoisomerase I Inhibitor for SCLC
A
- Irinotecan
- MoA: blocks the coiling and uncoiling of dsDNA during S phase - single and double stranded breaks in the DNA
- AEs: Diarrhea, acute cholinergic symptoms (atropine), myelosuppression
16
Q
Irinotecan Diarrhea Treatment
A
- Acute: atropine
- Delayed: treat with loperamide up to 24 mg/day
17
Q
Topoisomerase II Inhibitor for SCLC
A
- Etoposide
- MoA: blocks the coiling/uncoiling dsDNA during G2 (single/double stranded breaks in DNA)
- Infusion related hypotension - give over 30-60 minutes minimally
- D/C drug if hypotension starts and give fluids immediately, decrease rate when restarting
18
Q
Etoposide AEs
A
- Myelosuppression
- Hypersensitivity reactions
- Secondary Malignancies
19
Q
NSCLC - SCC
A
- Squamous cell carcinoma
- Associated with central lesions
- Associated with tobacco use
- Slow growing tumor with lower propensity to metastasize
20
Q
NSCLC - NSCC: Adenocarcinoma
A
- Most common
- Commonly occurs in peripheral lung
- Not associated with tobacco use
- Highly proliferative with a high propensity to metastasize early and widely
- Worse prognosis compared to SCC
21
Q
NSCLC - NSCC: Large Cell
A
- Large bulky peripheral
- Prognosis and treatment similar to adeno
22
Q
NSCLC Treatment
A
- Refer algorithm
- SCC: platinum-based doublet
- Adenocarcinoma/large cell: platinum-based doublet or pemetrexed with platinum
- Advanced/metastatic NSCLC: test for targeted therapies
23
Q
NSCLC Surgery
A
- Preferred approach for stage I/II disease because it offers the best chance of cure
- In general, Stage I-II and some stages IIIA are considered surgical candidates
- Sleeve lobectomy is preferred over pneumonectomy or wedge resection
- Relative contraindications: poor performance status, compromised CV fxn, poor pulmonary fxn
24
Q
NSCLC Radiation
A
-RT has potential role in all stages of NSCLC
General Indications
- Definitive treatment in combo with chemo for unresectable disease
- Adjuvant treatment in combo with chemo for positive margins
- Palliative treatment
25
Q
NSCLC Treatments
A
- SCC: platinum-based doublet
- Adenocarcinoma/large cell: platinum-based doublet or pemetrexed
- Different chemo options depending if neo/adjuvant RT or concurrent chemoradiation
- Targeted therapy is an option
26
Q
Pemetrexed
A
MoA: antifolate, inhibits multiple enzymes such as thymidylate synthase (TS)
- Use in nonsquamous only
- Pre-meds: B12, folic acid, dexamethasone
- Toxicities: Rash
27
Q
VEGF Inhibitors
A
- Bevacizumab or Ramucirumab
- Used for advanced stages
- Treatment and maintenance
- Both cause bleeding, hemoptysis, thrombosis, hypertension, proteinuria
28
Q
EGFR Inhibitors
A
- Osimertinib, Erlotinib, Afatinib, Gefetinib, Dacomatinib
- Epidermal growth factor receptor
- 10-15%
- Females, Asians, never smokers
- Toxicities: acneiform rash, GI (diarrhea), hepatic, ocular
29
Q
ALK Inhibitors
A
- Alectinib, Brigatinib, Ceritinib, Crizotinib, Lorlatinib
- Anaplastic lymphoma kinase fusion
- 4-8% of NSCLC patients
- No/light smoking, younger
- Toxicities: diarrhea, elevated LFTs, visual changes, QTc prolongation, edema
30
Q
ROS1
A
- Rearrangement mutation
- 1%
- Adenocarcinoma, never smokers, younger age
- Agents: Crizotinib, Ceritinib, Entrectinib, Lorlatinib
- Toxicities: Diarrhea, elevated LFTs, visual changes, QTc prolongation, edema
31
Q
NTRK Fusion
A
- Blanket approval for solid tumors expressing neurotrophic receptor tyrosine kinase
- Agents: Larotrectinib or Entrectinib
- Toxicities: Edema, anemia, diarrhea, constipation, increased SCr, neurotoxicity, dizziness, elevated LFTs
32
Q
BRAF-V600E
A
- 1-2%
- Current/former smokers
- Combination therapy to delay resistance and reduce toxicities
- Agents: Dabrafenib (BRAF inhibitor) + Tremetinib (MEK inhibitor)
- Toxicities: dermatologic, tolerance, diarrhea, pyrexia, chills
33
Q
PD-L1
A
- Programmed death checkpoint inhibitors
- Molecular testing to assess % expression
- Immunotherapy to enhance T-cell activity
- PD-1 Agents: Pembrolizumab or Nivolumab
- PD-L1 Agents: Atezolizumab or Durvalumab
- Toxicities: IRAE (Dermatologic, endocrine, GI, hepatic, renal, pneumonitis)
