Lung Cancer Therapeutics Flashcards
what are the 5 main mutations that can guide lung cancer therapy regimens
EGFR mutations
KRAS mutations
ALK inhibition
ROS-1 mutations
BRA V600E
what are the two main lung cancer groups
NSCLC
SCLC
describe SCLC
clear relationship to smoking
paraneoplastic syndromes common
rapid cell growth fraction
highly sensitive to radiation and chemotherapy
which lung cancer is highly sensitive to radiation and chemo
SCLC
what is a complication of therapy for SCLC
cisplatin complications (N/V, nephrotoxicity, ototoxicity, neuropathy
radiation complications
is surgery an option in SCLC
no
what is the intent in limited stage SCLC
curative intent
what is 1st line treatment for limited stage SCLC
combo chemo + radiation
cisplatin + etoposide w/ radiation
is maintenance chemo an option for limited stage SCLC
no there is no benefit
what is the intent with extensive stage SCLC
not curative. prolong survival
what is the preferred treatment option in extensive SCLC
platinum based therapy w/o radiation
-cisplatin/carboplatin + etoposide/irinotecan
what is first line immunotherapy for extensive SCLC
carboplatin + etoposide + durvalumab OR atezolizumab
is maintenance chemotherapy acceptable in extensive SCLC
yes
what is a treatment option for metastatic SCLC patients who have progressed on or after platinum chemo and at least 1 prior line of therapy
pembrolizumab
how to treat relapse of extensive SCLC
> 6 months: original regimen +/- mab
<=6 months: topotecan, clinical trial, or pembrolizumab
what are the two main forms of NSCLC
adenocarcinoma (non-smokers)
squamous (smokers)
what is the best treatment for NSCLC
surgery
what is the treatment for resectable NSCLC
- surgery to remove
- adjuvant chemo based on histology
what is the chemo regimen for resectable non-squamous NSCLC
cisplatin + premetrexed
what is the chemo regimen for resectable squamous NSCLC
cisplatin + gemcitabine
cisplatin + docetaxel
if a patient is unable to tolerate cisplatin, what can be substituted
carboplatin
what is the treatment regimen for unresectable NSCLC
chemo + radiation + consolidation w/ mab
what is the intent of treatment for unresectable NSCLC
stage IIIB/IV disease is palliative not curative
for patients with unresectable NSCLC who are not candidates for surgery or chemo + radiation what is the preferred treatment option
pembrolizumab
what is the chemo regimen for unresectable NSCLC
cisplatin + paclitaxel
cisplatin + gemcitabine
cisplatin + docetaxel
what drug should be followed by chemo regimen and for how long
Durvalumab and for 12 months for maintenance/consolidation therapy
what should be checked in all advance metastatic adenocarcinomas (non-squamous)
mutational status and PD-L1 status
what is first line for metastatic adenocarcinomas with a positive mutation
TKIs first then immunotherapy
what should be used with an EGFR + mutation (exon 19, exon 21, L858R mutation, T790M mutation)
Osimertinib
what are side effects with Osimertinib
cardiomyopathy, RASH
what should be used with a BRAF + mutation
Dabrafenib + Trametinib
what are side effects of dabrafenib + trametinib
fevers, rash, visual changes, retinal detachment
what should be used in K-RAS G12C mutation
Sotorasib
used after platinum based chemo +/- immunotherapy
what is a side effect of Sotorasib
increased LFTs
what is first line in metastatic adenocarcinoma with no mutation or oral chemo has been exhausted
Pembro or
Carbo + Pem ^2
what is the treatment for mutation negative PD-L1 negative metastatic adenocarcinom
carboplatin + pemetrexed + pembrolizumab
what is first line for metastatic squamous cell cancer
Pembrolizumab + Carboplatin + Paclitaxel
what is the treatment for a patient with a CI to immunotherapy with metastatic squamous cell cancer
platinum doublet regardless of PD-L1 status
what are the toxicities to immunotherapy
CHEN-P
Colitis
Hepatitis
Endocrine (thyroid/pituitary)
Nephritis
Pneumonitis
what 6 labs should be monitored for patients receiving immunotherapy
CBC diff
CMP (renal, liver, glucose)
TSH and Free T4
Amylase and lipase
who should consider lung cancer screening
patients at high risk
55-74 w/ 30 pack year of smoking and still in good health and willing to have curative surgery
