Lung Cancer Vignette Flashcards
Molecular biology in treatment of lung cancer?
Patients are tested for their molecular markers (EGFR activity, or ALK-EML4 activity). You then give appropriate treatment to target the tumor specifically based on this information.
Prognosis for lung cancer?
Look at genes that do DNA repair (ERCC and RMM). These increase prognosis but decrease chance of response to platinum based chemotherapy. Also look at stage of the cancer, Small cell vs. large cell, and type of tumor and tissue.
Lung cancer magnitude as an issue?
216,000 estimated new cases 2010 • 1 in 12 men • 1 in 16 women
• 160,000 deaths: > Breast + Prostate + Colon
Prognostic vs. predictive biomarkers
Two types of biomarkers:
Prognostic: reflect natural history of disease independent of therapy- based on the tumor and the patient themselves
Predictive: reflects the impact of a therapeutic intervention (predicts response to treatment).
2 types of lung cancer
SCLC (most aggressive, chemo, no targeted therapies, 15%).
NSCLC (chemo, molecular aberrations).
Now we have way more subtypes (sig. for targeted therapy)
EGFR/HER2
often over-expressed in early cancer development. Ligand or receptor over-expressed or mutation.
Current approved drug targets?
EGFR and ALK
EGFR target?
Can be via TKI inhibitor (like gefitinib, inside, milder toxicity) or antibodies (cetuximab, not yet approved).
ALK/EML4
A fusion in lung cancer. Key driver in NSCLC. 2-3% of patients, ALK inhibitor drug, good median PFS after chemo failure.
Immunotherapy
hasn’t really worked in past. Need to activate T cell (2 things required, antigen and co-stimulation).
PD1 on T cell, PD-L1 on lung cells.
PD-1
When activated in inhibits T cell fx. So we want to give PD1 inhibitor.
Nivolumab is PD-1 antibody
Lung cancer screening
Can use low-dose CT to screen high risk patients, you’ll pick up nodules not seen on x-ray (but 95% false positive), however does have impact on mortality.
Need improved imaging/biomarkers.
