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Phar 509 > Lung Cancer II: Regimens > Flashcards

Lung Cancer II: Regimens Flashcards

1
Q

What are ways that people are diagnosed with Lung Cancer

A

Laboratory testing (electrolytes, LFTs), Radiographic imaging, Tissue sampling, Immunohistochemical staining, biomaker analysis

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2
Q

What are the two most common types of Lung Cancer

A

Small cell (10-15%) and non small cell lung cancer (80-85%)

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3
Q

What are the two type of non small cell lung cancers

A

Non squamous cell and squamous cell

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4
Q

What are the two types of non squamous cell lung cancer types

A

Adenocarcinoma and Large cell

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5
Q

What is the natural history of Small Cell Lung Cancer (SCLC) and what is the treatments

A

Most aggressive (death in 2 to 4 months without treatment), clear relationship to smoking, parenoplastic syndromes are common, early development of widspread metastases/ highly sensitive to radiation and chemotherapy, NO SURGERY

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6
Q

What is the chemotherapy used to treat SCLC

A

Double Systemic chemotherapy: Cisplatin/Carboplatin PLUS Etoposide/Irinothecan

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7
Q

T/F: Limited stage is Stages 1-3 and Extensive Stage is considered Stage 4

A

True

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8
Q

What is the preferred regimen for Limited Stage SCLC

A

Cisplatin PLUS Etoposide PLUS concurrent Radiation Therapy

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9
Q

What are the Category 1 regimens for treatments options for treating Extensive stage SCLC

A

Carboplatin PLUS Etoposide PLUS Atezolizumab for 4 CYCLES THEN atezolizumab maintenance/ Carboplatin or Cisplatin PLUS Etoposide PLUS Durvalumab for 4 CYCLES then Durvalumab maintenance

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10
Q

What are the Category 2 regimens for treatment options for treating Extensive stage SCLC

A

Carboplatin PLUS Etoposide, Cisplatin PLUS Etoposide, Cisplatin PLUS Irinotecan, Carboplatin PLUS Irinotecan

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11
Q

What are the PD-1 antagonistis, PDL-1 antagonists, how are they dosed

A

Nivolumab and Pembrolizumab/ Atezolizumab and Durvalumab (every 3 to 4 weeks)

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12
Q

What medications should be avoided when using PD-1/PDL-1 antagonists

A

Corticosteroids

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13
Q

What cancers are Durvalumab approved for, Dose

A

SCLC and Unresectable Stage 3 Non-small lung cancer which has not progressed following concurrent platinum based chemotherapy and radiation therapy/ 10 mg/kg over IV every 2 weeks

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14
Q

T/F: PD-1 status is needed in order to PD-1 and PDL-1 antagonists to be used

A

False

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15
Q

What can be given if there is a relapse within 6 months of completion of therapy and the perfomance status is 0-2, greater than six months

A

Topotecan IV or by mouth, repeat the original regimen

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16
Q

Why would cranial radiation done for SCLC

A

Brain metastases is common in 50% of SCLC and can improve overall outcomes

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17
Q

What are common characteristics about Non-Small Cell Lung Cancer (NSCLC) that are adenocarcinomas, squamous cell carcinoma

A

Periphery of lungs, most common in NON-SMOKERS, higher incidence in women, linked to EGFR mutations/ clearly related to smoking, grow slower, better prognosis than adenocarcinomas

18
Q

What are general points about NSCLC as a whole

A

Slow growing, moderatively effected by radiation, low sensitivity to chemotherapy, untreated patients die within one year

19
Q

How is NSCLC managed, what can be used at all different stages, used up to Stage 3A

A

Surgery, Radiation therapy, Cytotoxic chemotherapy, targeted therapies/ radiation therapy and chemotherapy, Surgery

20
Q

T/F: Cisplatin therapy is used after surgery (adjuvant) or before surgery (neo-adjuvant) along with advanced NSCLC/carboplatin can be used to being unable to handle cisplatin

A

True

21
Q

T/F: Patients get Grade 3 and Grade 4 toxicitites 33 to 75 percent of the time requiring hospitalizations

A

True

22
Q

What are the neoadjuvant and adjuvant chemotherapy regimens regarding cisplatin, carboplatin

A

Cisplatin PLUS vinorelbine or etoposide or docetaxel or gemcitabine or premetrexed/ Carboplatin PLUS palcitaxel or gemcitabin or pemetrexed

23
Q

What are the molecular tests needed to treat 3B or Stage 4 NSCLC

A

PDL1 expression, EGFR expression (most common), ALK/ROS1 translocations, BRAF/V600E mutations, NTRK gene fusion

24
Q

What is the first line for therapy for the vast amount of patients with ADVANCED NSCLC without a driver mutation

A

Immunotherapy (PDL1 and PD1)

25
Q

What are the EGFR inhibitors

A

Elotanib, Aftainib, Dacomitinib, Gefitinib, Osimertinib

26
Q

What are the side effects of EGFR inhibitors

A

Acne forming rash, diarrhea, SJS, interstitual lung disease

27
Q

What is one of the rare mutations that make a patient resistant to EGFR inhibitors

A

ELM4-ALK fusion oncogene

28
Q

What are the ALK inhibitors

A

Alectinib, brigatinib, ceritinib,crizotinib,lorlatinib (used after other ALK inhibitors)

29
Q

What are the side effects of ALK inhibitors

A

QT prolongation, skin rash, N/V/D, edema

30
Q

Which ALK inhibitors are given with food, without

A

Alectinib, ceritinib/ brigatinib, crizotinib and lorlatinib

31
Q

What are the BRAF inhibitors

A

Vemurafenib and Dabrafenib (MUST HAVE V600E MUTATION)

32
Q

What are the BRAF inhibitor side effects

A

New Malignancies, QT prolongation, rash, fatigue

33
Q

What is the MEK inhibitor, side effects

A

Trametinib/ Hand foot syndrome, DVT/PE, hemorrhage, Left ventricular dysfunction

34
Q

T/F: BRAF and MEK are usually used in combination

A

True

35
Q

What are the two Tropomyosin receptor kinase (TRK) inhibitors

A

Larotrectinib and Entrectinib

36
Q

What are precautions with using Immune checkpoint inhibitors

A

Increase the risk of graft rejection, precipitate autoimmune disease, reduce the efficacy of systemic immunosuppresion

37
Q

What are common side effects of ICPis (can occur weeks, months, and years later)

A

Pneumotitis,hypo and hyperthyroidism, rash and vitiligo,entrocolitis

38
Q

What is commonly used for Non-squamous histology

A

Cisplatin or Carboplain PLUS paclitaxel or premetrexed

39
Q

What are other agents used in NSCLC

A

Bevacizumab, Ramucirumab

40
Q

What are the options for dealing with immune related adverse effects

A

Discontinue therapy and give corticosteroids

Phar 509 (22 decks)

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