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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
Q

What is the use of post-operative RT?

A

small reduction in mediastinal recurrence, but small increase in death rate actually

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26
Q

Standard treatment for stage IIIA resectable NSCLC?

A

ChemoRT + Durvalumab
(Cis + Pem for non-squamous)
(EP or Carbo/Taxol for squamous)

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27
Q

Treatment for stage IIIA patients who do not want chemoradiation?

A

Neoadjuvant chemo+Nivo

28
Q

Who should not get surgery in stage IIIA? (4)

A

Significant weight loss
PS>2
Borderline cardiorespiratory
Multilevel N2 disease

29
Q

Preferred treatment for metastatic PD-L1 negative adenocarcinoma with no driver mutation?

A

Platinum+Pemetrexed and maintenance Pem

30
Q

3 options for second line chemotherapy metastatic adenocarcinoma

A

Docetaxel + Ramicirumab
Pemetrexed
Docetaxel

31
Q

Which EGFR mutation has the best prognosis?

A

Exon 19 deletion

32
Q

What is the difference between EGFR Exon 20 mutation compared to 19 or 21?

A

Exon 20 is not responsive to osimertinib

33
Q

Treatment for EGFR exon 20 insertion mutations

A

Amivantimab
Mobocertinib

34
Q

Treatment for exon 20 T790M mutation

A

Osimertinib

35
Q

Treatment options for metastatic NSCLC with EGFR exon19 deletion or exon21L858R mutation? (5)

A

Osimertinib
Afatinib
Erlotinib (+/-ram)
Gefitinib
Dacomitinib

36
Q

Treatment for EGFR S768I mutation

A

Afatinib

37
Q

Treatment for EGFR L861Q mutation

A

Afatinib

38
Q

Treatment for EGFR G719X mutation

A

Afatinib

39
Q

Most common side effect of osimertinib

A

Diarrhea
Rash
Prolonged QT
Hyponatremia
ILD and Cardiomyopathy are rare

40
Q

Treatment for HER2 Exon 20 insertion mNSCLC?

A

Trastuzumab Deruxtecan

41
Q

What are the 5 medications approved for ALK mutated mNSCLC in the 1st line?

A

Alectinib
Brigatinib
Lorlatinib
Ceritinib
Crizotinib (inferior to above)

42
Q

What ALK inhibitor is approved in 2nd line setting?

A

Lorlatinib

43
Q

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?

A

Titrate dose from 90 mg to 180 to reduce risk of pneumonitis

44
Q

Treatment for KRAS G12c mutation? (2)

A

Sotorasib (2nd line only)
Adagrasib (2nd line only)

45
Q

Treatment for ROS-1 fusion mNSCLC? (3)

A

Crizotinib
Entrectinib
Repotrectinib

46
Q

Treatment for BRAF V600E mutated mNSCLC? (2)

A

Dabrafenib+Trametinib
Encorafenib+Binimetinib

47
Q

Treatment for MET exon14 mutation mNSCLC? (2)

A

Capmatinib
Tepotinib

48
Q

Treatment for RET fusion mNSCLC? (2)

A

Selpercatinib
Pralsetinib

49
Q

Preferred treatment for metastatic NSCLC without a driver mutation and PD-L1 >50%

A

IO alone or Ipi/Nivo
(Pembro, Atezo, Cemiplimab specifically)

50
Q

Preferred treatment for metastatic NSCLC without a driver mutation and PD-L1 1-49%

A

Chemo+Pembro or Ipi/Nivo or Atezo or Cemiplimab or Durvalumab +tremelimumab

51
Q

Preferred treatment for mNSCLC with no driver mutation and PD-L1 0%

A

Chemo+IO

52
Q

Patient with ALK mutated metastatic NSCLC treated with crizotinib in first line and progressed. What are four treatment options?

A

Alectinib
Brigatinib
Ceritinib
Lorlatinib

53
Q

Preferred treatment for metastatic squamous cell carcinoma with no driver mutation and PD-L1 0%?

A

Carboplatin + Paclitaxel (or abraxane) + Pembrolizumab

54
Q

Preferred treatment for metastatic adenocarcinoma with no driver mutation and PD-L1 0%

A

Carboplatin + Pemetrexed + Pembrolizumab

55
Q

Patient with two separate cancer nodules in the same lobe is classified as T_?

A

T3

56
Q

Patient with two separate cancer nodules in different lobes of the same lung is classified as T_?

A

T4

57
Q

Standard of care treatment paradigm for superior sulcus tumor (Pancoast tumor)

A

Neoadjuvant chemoRT followed by surgery. Then adjuvant chemotherapy.

58
Q

2 Most common mechanisms for acquired resistance to osimertinib?

A

MET amplification
EGFR C797S mutation

59
Q

Indication for adjuvant Alectinib?

A

Stage IB (>4 cm) to IIIA NSCLC with ALK rearrangement

60
Q

2 Most common side effects of crizotinib?

A

Visual disturbances
elevated LFTs

61
Q

How do you manage nephrotic syndrome from bevacizumab?

A

Discontinue bev

62
Q

What is the preferred ALK inhibitor to use when a patient develops resistance mutations?

A

Lorlatinib

63
Q

4 common/unique side effects of alectinib

A

Hepatotoxic
ILD
Bradycardia
Myalgia/CPK elevation

64
Q

Patient with metastatic EGFR mutated NSCLC on osimertinib has progression in multiple spots and is symptomatic. Next Treatment?

A

Amivantamab + Carboplatin + Pemetrexed

65
Q

Which ALK inhibitor has a warning about hyperlipidemia?

A

Lorlatinib

66
Q

What cardiac side effect is common among all ALK TKIs?

A

Bradycardia

Solid Tumor Oncology (20 decks)

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