Non-operative Management of Lung Cancer Flashcards
What is the most cancer worldwide ?
Lung cancer
What type of cancer makes up 85% of lung cancer ?
Non-small cell lung cancer:
- adenocarcinoma - squamous carcinoma - large cell carcinoma
What type of cancer makes up 15% of lung cancers ?
Small cell lung cancer
What is the ECOG performance status ?
0- asymptomatic, well 1- symptomatic, able to do light work 2- has to rest for <50% of the day 3- has to rest >50% of the day 4- bedbound 5- dead
What is the doubling time for NSCLC ?
129 days
How is NSCLC staged ?
Using TNM
What does stage IV mean ?
Distant metastasis
What % of NSCLC is operable ?
Maximum of 25%
What are all the therapeutic options for cancer ?
Surgery Adjuvant therapy Neo-adjuvant therapy Radiotherapy Chemotherapy Combination Targeted therapies
What determines the therapeutic options ?
Tumour type Stage ECOG performance status Patient wishes and options Aims of therapy (curative or palliative)
What is the average 5 year survival for non-small cell lung cancer ?
Overall 40%
When is surgery only offered ?
Only offered as a curative treatment
What is necessary for surgery ?
Good lung function necessary:
- FEV1 >1 for lobectomy
- FEV1 >2 for pneumectomy
Lymph node sampling essential
What is adjuvant therapy ?
When the cancer has appeared to all have been removed – but it is post operative treatment to ensure all cancer has been removed
Reduces risk of recurrence
What is neoadjuvant therapy ?
Neoadjuvant chemotherapy is delivered before surgery with the goal of shrinking a tumour or stopping the spread of cancer to make surgery less invasive and more effective.
What is radical radiotherapy ?
potentially curative treatment in NSCLC
Delivered in conventional 2-Gy fractions, hypo-fractionated and ablative stereotactic courses
What is the side effects of Radical radiotherapy ?
Acute- lethargy, oesophagitis, SOB due to pneumonitis
Long term- pulmonary fibrosis, oesphageal stricture, cardiac
What is the 5 year survival rate after radical radiotherapy ?
20%
What treatment is a systemic treatment ?
Chemotherapy
What is concurrent chemoradiotherapy ?
Highly efficacious locoregional treatment option for solid tumours
Better than with RT alone
no standard regime
What does the addition of chemo increase ?
Toxicity
What is the 2 year survival rate of concurrent chemoradiotherapy ?
27%
What percent of Non small cell lung cancer patients have advanced disease ?
80%
What is stage III ?
Very locally advanced disease
What are the palliation options ?
Chemo Immunotherapy TKI Palliative Radiotherapy Combination of all
What is palliative chemotherapy ?
Given as a doublet regime
3 as good as 6 cycles of chemo (4 is average in UK)
What is palliative immunotherapy ?
PDL1- prevents immune system attacking cells in the body
Cancers are good at masking themselves from immune system via PDL1 expression
Can be used 1st line if PDL1 score >50%
What should be considered in the case of Painful bone metastases and Brain metastases ?
Painful bone metastases - radiotherapy
Brain metastases - resection
What is pemetrexed used for ?
Maintenance chemotherapy
What is palliative TKIs ?
Targeted drugs for adenocarcinoma with driver mutations
Available for patients unfit for chemo (PS 0-3)
2nd line treatment options at progression
Understanding mechanisms of resistance- REBIOPSY
What are examples of Driver mutations for NSCLC ?
EGFR mutation
ALK translocation
BRAF mutation
ROS alteration
What is the concept for Tyrosine Kinase Inhibitors ?
Blocks Tyrosine Kinase which is a membrane receptor protein - This stops the formation of a protein causing the tumour to grow
What drugs are Tyrosine Kinase Inhibitors ?
Erlotinib
Gefitinib
Afatinib
What is palliative radiotherapy used for ?
Management of symptoms:
- bone metastasis - cord compression - haemoptysis
What is SABR ?
Stereotactic ablative RT
Can have similar outcomes to surgery
Tumours up to 4cm
>2cm away from airways and proximal bronchial tree
What % of patients have SCLC ?
15%
What is the doubling time for SCLC ?
29 days
What are the two classifications of Small cell lung cancer severity ?
Limited Disease - Staged to one hemithorax
Extensive disease - more advanced disease
How do you treat SCLC of limited disease ?
Chemotherapy
Combination of drugs including cisplatin and etoposide
Early thoracic radiotherapy is better
Prophylactic cranial radiation
In SCLC is there any benefit from any of the following?
High Dose chemo?
Alternating Chemo?
Maintenance Chemo?
Chemo ‘on demand’?
Maintenance interferon?
NO
What is median survival of limited disease SCLC with and without treatment ?
With - 8 months
Without - 16 months
What is the rate of two year survival with SCLC in limited disease ?
25%
What are the side effects to chemotherapy ?
Marrow suppression ( + risk of threatening infection)
Nausea, vomiting GI upset, mucositis, fatigue, lethargy
Neuropathy, increased risk of MI/ stroke, renal impairement
Hair loss, nail chnages
What are the side effects of radiotherapy ?
Lethargy, risk to surrounding organs
Acute: pneumonitis, dysphagia
Late: fibrosis, stricture, increased risk MI
What are the side effects of immunotherapy ?
Colitis, pneumonitis, dermatitis, endocrinopathies
