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PHRM 864 therapeutics > Lung Cancer Therapeutics > Flashcards

Lung Cancer Therapeutics Flashcards

1
Q

what are the 5 main mutations that can guide lung cancer therapy regimens

A

EGFR mutations
KRAS mutations
ALK inhibition
ROS-1 mutations
BRA V600E

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2
Q

what are the two main lung cancer groups

A

NSCLC
SCLC

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3
Q

describe SCLC

A

clear relationship to smoking
paraneoplastic syndromes common
rapid cell growth fraction
highly sensitive to radiation and chemotherapy

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4
Q

which lung cancer is highly sensitive to radiation and chemo

A

SCLC

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5
Q

what is a complication of therapy for SCLC

A

cisplatin complications (N/V, nephrotoxicity, ototoxicity, neuropathy
radiation complications

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6
Q

is surgery an option in SCLC

A

no

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7
Q

what is the intent in limited stage SCLC

A

curative intent

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8
Q

what is 1st line treatment for limited stage SCLC

A

combo chemo + radiation
cisplatin + etoposide w/ radiation

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9
Q

is maintenance chemo an option for limited stage SCLC

A

no there is no benefit

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10
Q

what is the intent with extensive stage SCLC

A

not curative. prolong survival

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11
Q

what is the preferred treatment option in extensive SCLC

A

platinum based therapy w/o radiation
-cisplatin/carboplatin + etoposide/irinotecan

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12
Q

what is first line immunotherapy for extensive SCLC

A

carboplatin + etoposide + durvalumab OR atezolizumab

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13
Q

is maintenance chemotherapy acceptable in extensive SCLC

A

yes

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14
Q

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

A

pembrolizumab

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15
Q

how to treat relapse of extensive SCLC

A

> 6 months: original regimen +/- mab
<=6 months: topotecan, clinical trial, or pembrolizumab

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16
Q

what are the two main forms of NSCLC

A

adenocarcinoma (non-smokers)
squamous (smokers)

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17
Q

what is the best treatment for NSCLC

A

surgery

18
Q

what is the treatment for resectable NSCLC

A
  1. surgery to remove
  2. adjuvant chemo based on histology
19
Q

what is the chemo regimen for resectable non-squamous NSCLC

A

cisplatin + premetrexed

20
Q

what is the chemo regimen for resectable squamous NSCLC

A

cisplatin + gemcitabine
cisplatin + docetaxel

21
Q

if a patient is unable to tolerate cisplatin, what can be substituted

A

carboplatin

22
Q

what is the treatment regimen for unresectable NSCLC

A

chemo + radiation + consolidation w/ mab

23
Q

what is the intent of treatment for unresectable NSCLC

A

stage IIIB/IV disease is palliative not curative

24
Q

for patients with unresectable NSCLC who are not candidates for surgery or chemo + radiation what is the preferred treatment option

A

pembrolizumab

25
Q

what is the chemo regimen for unresectable NSCLC

A

cisplatin + paclitaxel
cisplatin + gemcitabine
cisplatin + docetaxel

26
Q

what drug should be followed by chemo regimen and for how long

A

Durvalumab and for 12 months for maintenance/consolidation therapy

27
Q

what should be checked in all advance metastatic adenocarcinomas (non-squamous)

A

mutational status and PD-L1 status

28
Q

what is first line for metastatic adenocarcinomas with a positive mutation

A

TKIs first then immunotherapy

29
Q

what should be used with an EGFR + mutation (exon 19, exon 21, L858R mutation, T790M mutation)

A

Osimertinib

30
Q

what are side effects with Osimertinib

A

cardiomyopathy, RASH

31
Q

what should be used with a BRAF + mutation

A

Dabrafenib + Trametinib

32
Q

what are side effects of dabrafenib + trametinib

A

fevers, rash, visual changes, retinal detachment

33
Q

what should be used in K-RAS G12C mutation

A

Sotorasib
used after platinum based chemo +/- immunotherapy

34
Q

what is a side effect of Sotorasib

A

increased LFTs

35
Q

what is first line in metastatic adenocarcinoma with no mutation or oral chemo has been exhausted

A

Pembro or
Carbo + Pem ^2

36
Q

what is the treatment for mutation negative PD-L1 negative metastatic adenocarcinom

A

carboplatin + pemetrexed + pembrolizumab

37
Q

what is first line for metastatic squamous cell cancer

A

Pembrolizumab + Carboplatin + Paclitaxel

38
Q

what is the treatment for a patient with a CI to immunotherapy with metastatic squamous cell cancer

A

platinum doublet regardless of PD-L1 status

39
Q

what are the toxicities to immunotherapy

A

CHEN-P
Colitis
Hepatitis
Endocrine (thyroid/pituitary)
Nephritis
Pneumonitis

40
Q

what 6 labs should be monitored for patients receiving immunotherapy

A

CBC diff
CMP (renal, liver, glucose)
TSH and Free T4
Amylase and lipase

41
Q

who should consider lung cancer screening

A

patients at high risk
55-74 w/ 30 pack year of smoking and still in good health and willing to have curative surgery

PHRM 864 therapeutics (26 decks)

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