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847 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Local Signs/Symptoms

A
  • Cough
  • Hemoptysis
  • Wheezing
  • Fever
  • Dyspnea
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2
Q

Metastases Signs/Symptoms

A
  • Weight loss
  • Bone pain
  • Fatigue
  • Neurologic symptoms
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3
Q

Prevention

A
  • Preferred over screening
  • Smoking cessation - decreases secondary primary cancer
  • Non-smokers have better tolerance and response to treatment
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4
Q

Low Risk + Screening

A
  • <50 and or <20 pack-year history of smoking

- No screening recommended

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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
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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
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7
Q

Limited vs Extensive Stage

A
  • Limited Stage - Stages I-III of SCLC

- Extensive Stage - Stage IV SCLC

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8
Q

SCLC Treatment

A
  • Sensitive to chemo + RT
  • Systemic chemotherapy is backbone
  • Differs based on limited or extensive stage
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9
Q

Limited Stage Treatment

A
  • Surgery - rare
  • Lobectomy is preferred
  • Chemo + RT q28D for 4 cycles
  • Prophylactic cranial irradiation (PCI)
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10
Q

Extensive Stage Treatment

A
  • Chemo

- Consider PCI or MRI brain surveillance

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11
Q

Relapsed/Refractory SCLC Treatments

A
  • > 6 mo after treatment - repeat initial regimen

- =< 6 mo after treatment - single agent regimen

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12
Q

Single Agent Options

A
  • Lurbinectedin
  • Docetaxel
  • Gemcitabine
  • Etoposide PO
  • Irinotecan
  • Paclitaxel
  • Temozolomide
  • Topotecan (PO or IV)
  • Vinorelbine
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13
Q

Platinums

A
  • Cisplatin- give with Amifostine to prevent nephrotoxicity

- Carboplatin - Dose = TargetAUC * (GFR+25), GFR capped at 125

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14
Q

Platinum AEs

A
  • Hypersensitivity rxn
  • Nephrotoxicity
  • Myelosuppression
  • N/V - cisplatin causes acute and delayed
  • Neuropathy
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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
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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)

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