Lung Cancer - Block 4 Flashcards
RF of lung cancer?
- Smoking
- Environmental respiratory carcinogens
- 1st degree relative
- Inflammaotry dx (COPD asthma)
How do screen for lung cancer?
Low dose computer tomography
How meets the criteria for lung cancer screening?
- 55-74 YO
- ≥30 ppy
- Have quit smoking less than 15 years ago
What are the presentations of lung cancer?
- Cough
- Hemoptysis
- Dyspnea/wheezing
- Chest pain/discomfort
- Rust streaked or purulent sputum
- Chest, shoulder, arm pain
- Dysphagia
- ANemia, weight loss fatigue
Diagnostic tools for lung cancer?
- Imaging
- Biopsy (squamous cell, adenocarcinoma, large cell, small cell)
What are the small cell lung cancer?
- Small cell carcinoma
- Combined cell carcinoma
What are the non-small cell lung cancer?
- Adenocarcinoma
- Large cell carcinoma
- Squamous cell
Characteristics of SCLC?
- Very aggressive
- Rapidly growing
- Early development of metastases
- Always associated with smoking
What is the difference between limited and extensive SCLC?
Limited: tumor confined to the lung
* Limited or no nodal involvement
* Stages 1-2
Extensive:
* Any progression beyond limited
* Stage 3-4
Tx for limited stage?
- Surgery (limited use unless solitary nodules)
- Radiation is preferred over surgery
- Radiation therapy + chemo
- Prophylactic cranial irradiation (PCI) offered to pts with complete response and prevention of recurrence
Chemo used with radiation for SCLC?
Etoposide and cisplatin for 4-6 cycles
* May use carboplatin if ADRs of cisplatin are too severe
What are the outcomes of recurrent dx?
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
TX for extensive SCLC?
- Chemotherapy alone
- EP (Etoposide plus cisplatin or carboplatin)
What is considered 2nd line “first line” for recurrance dx?
Topotecan IV/PO
OR irinotecan, gemcitabine, pacitaxel, doxetaxel, vinorelbine
What are the tx option for NSCLC?
- Surgery tx of choice
- Radiation
- Chemotherapy
- Targeted therapies
What are the types of NSCLC?
- Adenocarcinomas (non-smokers)
- Squamous cell carcinomas
- Large cell carcinomas
Describe the staging of NSCLC?
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
Stage 1 tx for NSCLC?
Negative margins:
* Observation after surgery
* Chemo for high-risk patients
Positive margins:
* Re-resection (preferred) +/- chemo
* Radiation therapy +/- chemotherapy
Stage 2 tx for NSCLC?
Negative margins: Chemo
Positive margins:
* Re-resection (preferred) + chemotherapy
* Chemoradiation (sequential or concurrent)
Stage 3 tx for NSCLC?
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)
Biomarkers you look for in NSCLC?
EGFR mutation (EGFR inhibitors)
EML4-ALK mutation (ALK inhibitors)
KRAS
EGFR inhibitors?
Erlotinib
Gefitinib
Afatanib
ALK inhibitors?
Crizotinib
Certinib
Alectinib
Chemo used for NSCLC?
- Cisplatin/etoposide
- Cisplatin/Vinorelbine
- Carboplatin/pacitaxel
- Cisplatin/pemetrexed
ADRs of EGFR inhibitors?
Intestinal lung dx
DDI of EGFR inhibitors?
Warfarin for gefitinib or erlotinib
May need topical or oral therapy for rash as with erlotinib and afatinib
Counseling for gefitinib and erlotinib?
PPIs, antacids, H2RAs decrease absorption (Avoid if possible)
CYP3A4 substrates
First line for ALK+ NSCLC?
Crizotinib
ADRs of crizotinib?
Vision disorders
Diarrhea, nausea
Infections
Elevated LFTs
Severe pneumonitis
QTc prolongation
ADR of Ceritinib?
Diarrhea
Hepatotoxicity
Visual impairment
Interstitial lung disease
QTc prolongation
eritinib
ADR of alectinib?
Elevated LFT’s
Myalgias
Photosenstivity
Interstitial lung disease
Tx for Stage IV lung cancer non squamous?
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
Tx for Stage IV lung cancer squamous cell?
EGFR/ALK mutation negative (PS 0-2):
* NO BEVACIZUMAB
* Cisplatin/gemcitabine
EGFR/ALK mutation negative (PS 3-4): Best supportive care
