Lung Cancer II: Regimens Flashcards
What are ways that people are diagnosed with Lung Cancer
Laboratory testing (electrolytes, LFTs), Radiographic imaging, Tissue sampling, Immunohistochemical staining, biomaker analysis
What are the two most common types of Lung Cancer
Small cell (10-15%) and non small cell lung cancer (80-85%)
What are the two type of non small cell lung cancers
Non squamous cell and squamous cell
What are the two types of non squamous cell lung cancer types
Adenocarcinoma and Large cell
What is the natural history of Small Cell Lung Cancer (SCLC) and what is the treatments
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
What is the chemotherapy used to treat SCLC
Double Systemic chemotherapy: Cisplatin/Carboplatin PLUS Etoposide/Irinothecan
T/F: Limited stage is Stages 1-3 and Extensive Stage is considered Stage 4
True
What is the preferred regimen for Limited Stage SCLC
Cisplatin PLUS Etoposide PLUS concurrent Radiation Therapy
What are the Category 1 regimens for treatments options for treating Extensive stage SCLC
Carboplatin PLUS Etoposide PLUS Atezolizumab for 4 CYCLES THEN atezolizumab maintenance/ Carboplatin or Cisplatin PLUS Etoposide PLUS Durvalumab for 4 CYCLES then Durvalumab maintenance
What are the Category 2 regimens for treatment options for treating Extensive stage SCLC
Carboplatin PLUS Etoposide, Cisplatin PLUS Etoposide, Cisplatin PLUS Irinotecan, Carboplatin PLUS Irinotecan
What are the PD-1 antagonistis, PDL-1 antagonists, how are they dosed
Nivolumab and Pembrolizumab/ Atezolizumab and Durvalumab (every 3 to 4 weeks)
What medications should be avoided when using PD-1/PDL-1 antagonists
Corticosteroids
What cancers are Durvalumab approved for, Dose
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
T/F: PD-1 status is needed in order to PD-1 and PDL-1 antagonists to be used
False
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
Topotecan IV or by mouth, repeat the original regimen
Why would cranial radiation done for SCLC
Brain metastases is common in 50% of SCLC and can improve overall outcomes
What are common characteristics about Non-Small Cell Lung Cancer (NSCLC) that are adenocarcinomas, squamous cell carcinoma
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
What are general points about NSCLC as a whole
Slow growing, moderatively effected by radiation, low sensitivity to chemotherapy, untreated patients die within one year
How is NSCLC managed, what can be used at all different stages, used up to Stage 3A
Surgery, Radiation therapy, Cytotoxic chemotherapy, targeted therapies/ radiation therapy and chemotherapy, Surgery
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
True
T/F: Patients get Grade 3 and Grade 4 toxicitites 33 to 75 percent of the time requiring hospitalizations
True
What are the neoadjuvant and adjuvant chemotherapy regimens regarding cisplatin, carboplatin
Cisplatin PLUS vinorelbine or etoposide or docetaxel or gemcitabine or premetrexed/ Carboplatin PLUS palcitaxel or gemcitabin or pemetrexed
What are the molecular tests needed to treat 3B or Stage 4 NSCLC
PDL1 expression, EGFR expression (most common), ALK/ROS1 translocations, BRAF/V600E mutations, NTRK gene fusion
What is the first line for therapy for the vast amount of patients with ADVANCED NSCLC without a driver mutation
Immunotherapy (PDL1 and PD1)
What are the EGFR inhibitors
Elotanib, Aftainib, Dacomitinib, Gefitinib, Osimertinib
What are the side effects of EGFR inhibitors
Acne forming rash, diarrhea, SJS, interstitual lung disease
What is one of the rare mutations that make a patient resistant to EGFR inhibitors
ELM4-ALK fusion oncogene
What are the ALK inhibitors
Alectinib, brigatinib, ceritinib,crizotinib,lorlatinib (used after other ALK inhibitors)
What are the side effects of ALK inhibitors
QT prolongation, skin rash, N/V/D, edema
Which ALK inhibitors are given with food, without
Alectinib, ceritinib/ brigatinib, crizotinib and lorlatinib
What are the BRAF inhibitors
Vemurafenib and Dabrafenib (MUST HAVE V600E MUTATION)
What are the BRAF inhibitor side effects
New Malignancies, QT prolongation, rash, fatigue
What is the MEK inhibitor, side effects
Trametinib/ Hand foot syndrome, DVT/PE, hemorrhage, Left ventricular dysfunction
T/F: BRAF and MEK are usually used in combination
True
What are the two Tropomyosin receptor kinase (TRK) inhibitors
Larotrectinib and Entrectinib
What are precautions with using Immune checkpoint inhibitors
Increase the risk of graft rejection, precipitate autoimmune disease, reduce the efficacy of systemic immunosuppresion
What are common side effects of ICPis (can occur weeks, months, and years later)
Pneumotitis,hypo and hyperthyroidism, rash and vitiligo,entrocolitis
What is commonly used for Non-squamous histology
Cisplatin or Carboplain PLUS paclitaxel or premetrexed
What are other agents used in NSCLC
Bevacizumab, Ramucirumab
What are the options for dealing with immune related adverse effects
Discontinue therapy and give corticosteroids
