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Therapeutics IV > Lung Cancer - Block 4 > Flashcards

Lung Cancer - Block 4 Flashcards

1
Q

RF of lung cancer?

A
  1. Smoking
  2. Environmental respiratory carcinogens
  3. 1st degree relative
  4. Inflammaotry dx (COPD asthma)
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2
Q

How do screen for lung cancer?

A

Low dose computer tomography

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3
Q

How meets the criteria for lung cancer screening?

A
  1. 55-74 YO
  2. ≥30 ppy
  3. Have quit smoking less than 15 years ago
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4
Q

What are the presentations of lung cancer?

A
  1. Cough
  2. Hemoptysis
  3. Dyspnea/wheezing
  4. Chest pain/discomfort
  5. Rust streaked or purulent sputum
  6. Chest, shoulder, arm pain
  7. Dysphagia
  8. ANemia, weight loss fatigue
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5
Q

Diagnostic tools for lung cancer?

A
  1. Imaging
  2. Biopsy (squamous cell, adenocarcinoma, large cell, small cell)
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6
Q

What are the small cell lung cancer?

A
  1. Small cell carcinoma
  2. Combined cell carcinoma
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7
Q

What are the non-small cell lung cancer?

A
  1. Adenocarcinoma
  2. Large cell carcinoma
  3. Squamous cell
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8
Q

Characteristics of SCLC?

A
  1. Very aggressive
  2. Rapidly growing
  3. Early development of metastases
  4. Always associated with smoking
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9
Q

What is the difference between limited and extensive SCLC?

A

Limited: tumor confined to the lung
* Limited or no nodal involvement
* Stages 1-2

Extensive:
* Any progression beyond limited
* Stage 3-4

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10
Q

Tx for limited stage?

A
  1. Surgery (limited use unless solitary nodules)
  2. Radiation is preferred over surgery
  3. Radiation therapy + chemo
  4. Prophylactic cranial irradiation (PCI) offered to pts with complete response and prevention of recurrence
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11
Q

Chemo used with radiation for SCLC?

A

Etoposide and cisplatin for 4-6 cycles
* May use carboplatin if ADRs of cisplatin are too severe

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12
Q

What are the outcomes of recurrent dx?

A

Less responsive to chemo after recurrence
* Tx based on time between induction therapy and relapse
* < 3 months -> unlikely to respone to tx
* > 3 months -> 25% chance of response, use 2nd line tx

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13
Q

TX for extensive SCLC?

A
  1. Chemotherapy alone
  2. EP (Etoposide plus cisplatin or carboplatin)
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14
Q

What is considered 2nd line “first line” for recurrance dx?

A

Topotecan IV/PO
OR irinotecan, gemcitabine, pacitaxel, doxetaxel, vinorelbine

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15
Q

What are the tx option for NSCLC?

A
  1. Surgery tx of choice
  2. Radiation
  3. Chemotherapy
  4. Targeted therapies
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16
Q

What are the types of NSCLC?

A
  1. Adenocarcinomas (non-smokers)
  2. Squamous cell carcinomas
  3. Large cell carcinomas
17
Q

Describe the staging of NSCLC?

A

Stage 1: Tumor confined to lung
2: Large tumors or tumors with initial lymph node involvement
3: more extensive nodual or regional involvement
IV: contralateral lung, metastatic dx or pleural effusion

18
Q

Stage 1 tx for NSCLC?

A

Negative margins:
* Observation after surgery
* Chemo for high-risk patients

Positive margins:
* Re-resection (preferred) +/- chemo
* Radiation therapy +/- chemotherapy

19
Q

Stage 2 tx for NSCLC?

A

Negative margins: Chemo
Positive margins:
* Re-resection (preferred) + chemotherapy
* Chemoradiation (sequential or concurrent)

20
Q

Stage 3 tx for NSCLC?

A

Negative margins:
* Chemotherapy OR
Chemoradiation (before or after surgery)

Tx based on genetic findings:
* Crizotinib for ALK +
* Erlotinib for EGFR +

Positive margins:
* Re-resection (preferred) + chemotherapy
* Chemoradiation (sequential or concurrent)

21
Q

Biomarkers you look for in NSCLC?

A

EGFR mutation (EGFR inhibitors)
EML4-ALK mutation (ALK inhibitors)
KRAS

22
Q

EGFR inhibitors?

A

Erlotinib
Gefitinib
Afatanib

23
Q

ALK inhibitors?

A

Crizotinib
Certinib
Alectinib

24
Q

Chemo used for NSCLC?

A
  1. Cisplatin/etoposide
  2. Cisplatin/Vinorelbine
  3. Carboplatin/pacitaxel
  4. Cisplatin/pemetrexed
25
Q

ADRs of EGFR inhibitors?

A

Intestinal lung dx

26
Q

DDI of EGFR inhibitors?

A

Warfarin for gefitinib or erlotinib

May need topical or oral therapy for rash as with erlotinib and afatinib

27
Q

Counseling for gefitinib and erlotinib?

A

PPIs, antacids, H2RAs decrease absorption (Avoid if possible)

CYP3A4 substrates

28
Q

First line for ALK+ NSCLC?

A

Crizotinib

29
Q

ADRs of crizotinib?

A

Vision disorders
Diarrhea, nausea
Infections
Elevated LFTs
Severe pneumonitis

QTc prolongation

30
Q

ADR of Ceritinib?

A

Diarrhea
Hepatotoxicity
Visual impairment
Interstitial lung disease

QTc prolongation

31
Q

eritinib

ADR of alectinib?

A

Elevated LFT’s
Myalgias
Photosenstivity
Interstitial lung disease

32
Q

Tx for Stage IV lung cancer non squamous?

A

EGFR +: erlotinib, afatinib, gefitinib
ALK +: Crizotinib
EGFR/ALK mutation negative (PS 0-1): Cisplatin or carboplatin/pemetrexed
* Platinum doublet ± Bevacizumab

EGFR/ALK mutation negative (PS 2): Carboplatin/pemetrexed
Single agent therapy

EGFR mutation negative
PS 3-4: Best supportive care

33
Q

Tx for Stage IV lung cancer squamous cell?

A

EGFR/ALK mutation negative (PS 0-2):
* NO BEVACIZUMAB
* Cisplatin/gemcitabine

EGFR/ALK mutation negative (PS 3-4): Best supportive care

Therapeutics IV (39 decks)

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