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Solid Tumor Oncology > Non-Small Cell Lung Cancer > Flashcards

Non-Small Cell Lung Cancer Flashcards

1
Q

T stage for NSCLC

A

T1a: <1 cm
T1b: 1-2 cm
T1c: 2-3 cm
T2a: 3-4 cm
T2b: 4-5 cm
T3: 5-7 cm
T4: >7 cm or Local invasion

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2
Q

IHC findings for adenocarcinoma

A

TTF+
Cytokeratin7+
Cytokeratin 20-

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3
Q

IHC findings of squamous cell carcinoma

A

p63+
p40+

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4
Q

What is a simplified way to think of stage I NSCLC?

A

Tumor <4 cm without LN

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5
Q

What is a simplified way to think of satge II NSCLC?

A

With peribronchial LN+ (N1)

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6
Q

What is a simplified way to think of tage III NSCLC?

A

Contralateral LNs, or mediastinal LNs (N2/N3)

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7
Q

Single digit thoracic LN stations are N_?

A

N2

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8
Q

Double digit LN stations are N_?

A

N1

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9
Q

What LNs are classified as N3?

A

Contralateral LNs or supraclavicular

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10
Q

What LN stations are classified as N1?

A

Double digit LNs

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11
Q

What LN stations are classified as N2?

A

Single digit LNs (mediastinal LNs)

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12
Q

What is adequate cardiopulmonary reserve for surgery?

A

> 40% post-op predicted FEV-1 and DLCO

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13
Q

For patients with <2 cm NSCLC and N0. What is the preferred surgery?

A

Sublobar resection (segmentectomy or wedge resection)

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14
Q

What is the preferred definitive treatment option for patients with stage I NSCLC who decline surgery?

A

SBRT

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15
Q

What are predictors of poor outcomes for surgical NSCLC resection? (2)

A

Delayed surgery >12 weeks
R1+ surgical resection

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16
Q

Who should get adjuvant chemotherapy?

A

Stage II or III
(T2b or higher, or N+)

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17
Q

Preferred adjuvant chemotherapy regimen for PD-L1 negative adenocarcinoma?

A

Cisplatin + Pemetrexed

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18
Q

Preferred adjuvant chemotherapy regimen for PDL-1 negative squamous cell carcinoma?

A

Cisplatin + Docetaxel (or taxotere)

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19
Q

What is the difference in outcomes between neoadjuvant and adjuvant chemotherapy?

A

Magnitude of survival difference is the same

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20
Q

What is the indication for adjuvant atezolizumab?

A

PDL1 >1% stage II-III

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21
Q

What is the indication for adjuvant pembrolizumab?

A

Any PD-L1
Stage I-III

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22
Q

What chemoimmunotherapy regimen is approved in the neoadjuvant setting?

A

Platinum doublet (including carbo) + Nivo
–Approved for any PD-L1 level

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23
Q

Chemotherapy + nivolumab in the neoadjuvant setting benefits what patient subpopulations the most?

A

PD-L1+ (especially >50%)
Stage III

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24
Q

Indications for adjuvant osimertinib?

A

EGFR ex19del (or ex21 L868R but less effective)
Stage IB-IIIA

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25
What is the use of post-operative RT?
small reduction in mediastinal recurrence, but small increase in death rate actually
26
Standard treatment for stage IIIA resectable NSCLC?
ChemoRT + Durvalumab (Cis + Pem for non-squamous) (EP or Carbo/Taxol for squamous)
27
Treatment for stage IIIA patients who do not want chemoradiation?
Neoadjuvant chemo+Nivo
28
Who should not get surgery in stage IIIA? (4)
Significant weight loss PS>2 Borderline cardiorespiratory Multilevel N2 disease
29
Preferred treatment for metastatic PD-L1 negative adenocarcinoma with no driver mutation?
Platinum+Pemetrexed and maintenance Pem
30
3 options for second line chemotherapy metastatic adenocarcinoma
Docetaxel + Ramicirumab Pemetrexed Docetaxel
31
Which EGFR mutation has the best prognosis?
Exon 19 deletion
32
What is the difference between EGFR Exon 20 mutation compared to 19 or 21?
Exon 20 is not responsive to osimertinib
33
Treatment for EGFR exon 20 insertion mutations
Amivantimab Mobocertinib
34
Treatment for exon 20 T790M mutation
Osimertinib
35
Treatment options for metastatic NSCLC with EGFR exon19 deletion or exon21L858R mutation? (5)
Osimertinib Afatinib Erlotinib (+/-ram) Gefitinib Dacomitinib
36
Treatment for EGFR S768I mutation
Afatinib
37
Treatment for EGFR L861Q mutation
Afatinib
38
Treatment for EGFR G719X mutation
Afatinib
39
Most common side effect of osimertinib
Diarrhea Rash Prolonged QT Hyponatremia ILD and Cardiomyopathy are rare
40
Treatment for HER2 Exon 20 insertion mNSCLC?
Trastuzumab Deruxtecan
41
What are the 5 medications approved for ALK mutated mNSCLC in the 1st line?
Alectinib Brigatinib Lorlatinib Ceritinib Crizotinib (inferior to above)
42
What ALK inhibitor is approved in 2nd line setting?
Lorlatinib
43
Treatment a patient with metastatic NSCLC with ALK mutation with brigatinib. What side effect do you need to be watchful of and what do you need to do to prevent it?
Titrate dose from 90 mg to 180 to reduce risk of pneumonitis
44
Treatment for KRAS G12c mutation? (2)
Sotorasib (2nd line only) Adagrasib (2nd line only)
45
Treatment for ROS-1 fusion mNSCLC? (3)
Crizotinib Entrectinib Repotrectinib
46
Treatment for BRAF V600E mutated mNSCLC? (2)
Dabrafenib+Trametinib Encorafenib+Binimetinib
47
Treatment for MET exon14 mutation mNSCLC? (2)
Capmatinib Tepotinib
48
Treatment for RET fusion mNSCLC? (2)
Selpercatinib Pralsetinib
49
Preferred treatment for metastatic NSCLC without a driver mutation and PD-L1 >50%
IO alone or Ipi/Nivo (Pembro, Atezo, Cemiplimab specifically)
50
Preferred treatment for metastatic NSCLC without a driver mutation and PD-L1 1-49%
Chemo+Pembro or Ipi/Nivo or Atezo or Cemiplimab or Durvalumab +tremelimumab
51
Preferred treatment for mNSCLC with no driver mutation and PD-L1 0%
Chemo+IO
52
Patient with ALK mutated metastatic NSCLC treated with crizotinib in first line and progressed. What are four treatment options?
Alectinib Brigatinib Ceritinib Lorlatinib
53
Preferred treatment for metastatic squamous cell carcinoma with no driver mutation and PD-L1 0%?
Carboplatin + Paclitaxel (or abraxane) + Pembrolizumab
54
Preferred treatment for metastatic adenocarcinoma with no driver mutation and PD-L1 0%
Carboplatin + Pemetrexed + Pembrolizumab
55
Patient with two separate cancer nodules in the same lobe is classified as T_?
T3
56
Patient with two separate cancer nodules in different lobes of the same lung is classified as T_?
T4
57
Standard of care treatment paradigm for superior sulcus tumor (Pancoast tumor)
Neoadjuvant chemoRT followed by surgery. Then adjuvant chemotherapy.
58
2 Most common mechanisms for acquired resistance to osimertinib?
MET amplification EGFR C797S mutation
59
Indication for adjuvant Alectinib?
Stage IB (>4 cm) to IIIA NSCLC with ALK rearrangement
60
2 Most common side effects of crizotinib?
Visual disturbances elevated LFTs
61
How do you manage nephrotic syndrome from bevacizumab?
Discontinue bev
62
What is the preferred ALK inhibitor to use when a patient develops resistance mutations?
Lorlatinib
63
4 common/unique side effects of alectinib
Hepatotoxic ILD Bradycardia Myalgia/CPK elevation
64
Patient with metastatic EGFR mutated NSCLC on osimertinib has progression in multiple spots and is symptomatic. Next Treatment?
Amivantamab + Carboplatin + Pemetrexed
65
Which ALK inhibitor has a warning about hyperlipidemia?
Lorlatinib
66
What cardiac side effect is common among all ALK TKIs?
Bradycardia

Solid Tumor Oncology (20 decks)

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