Non Surgical Management Of Lung Cancer

Question 1

How much lung cancer is non small cell

Answer 1

85% (adenocarcinoma then squamous then large)

Question 2

Doubling time of non small cell lung cancer

Answer 2

129 days

Question 3

How much non small cell lung cancer is resectable

Answer 3

25%

Question 4

MDT meetings

Answer 4

Discuss staging, tumour type, PMH, ECOG performance status

Question 5

ECOG

Answer 5

0-4, 4 is bedbound

Question 6

5 year survival of NSCLC after surgery

Answer 6

40%

Question 7

Adjuvant therapy for NSCLC surgery

Answer 7

Chemo eg cisplatin but NOT radiotherapy

Question 8

Adjuvant immunotherapy

Answer 8

Pacific trial for durvlumab for stage 3 NSCLC, has no significant effect on QoL but improves survival

Question 9

Neoadjuvant therapy for NSCLC surgery

Answer 9

Chemo for stage 3 and maybe radiotherapy

Question 10

Radical radiotherapy for stage 3 NSCLC

Answer 10

55Gy dose, 20% 5y survival

Question 11

SABR

Answer 11

Sterotactic ablative radiotherapy
54Gy in 3 fractions, can have similar outcomes to surgery for tumours up to 4cm and over 2cm away from airways and proximal bronchial tree

Question 12

Advanced NSCLC occurence

Answer 12

In 80% of diagnosed patients. 30% in stage 3 have invasions and 60% in stage 4 have metastasis

Question 13

Stage 4 NSCLC treatments

Answer 13

Incurable, only palliative care can be given up to 70% symptom benefit from RT but chemo gives this too plus survival benefit, increasing survival median to over a year

Question 14

Treating stage 3 and 4 NSCLC

Answer 14

3 as good as 6 chemo rounds, immunotherapy can be used for metastasis

Question 15

Bone pain from metastases timings, causes and treatment

Answer 15

Worse at night, pathological fractures, given palliative RT

Question 16

New drugs for NSCLC

Answer 16

Targeted adenocarcinoma drugs for driver mutations eg erlotinib etc for EGFR, if patients can’t have chemo

Question 17

Tyrosine kinase inhibitors examples and uses

Answer 17

Erlotinib, gefitinib, afatinib can improve response and survival in treating advanced solid tumours

Question 18

Nivolumab

Answer 18

Blocks the binding of PD1 on T cells to PDL1 on tumours so T cells aren’t inactivated

Question 19

Doubling time of SCLC

Answer 19

29 days

Question 20

Treatment for LD SCLC

Answer 20

Chemotherapy combos eg cisplatin and etopisode, with early thoracic RT and prophylactic cranial RT

Question 21

SCLC treatment outcomes for Limited Disease

Answer 21

Doubles survival median from 8 to 16 months, 90% response rate but 25% two year survival

Question 22

Treatment for extensive SCLC

Answer 22

4 cycles of combo chemo with thoracic RT, PCI recommended (prophylactic cranial irradiation)

Question 23

Outcomes of treated ED SCLC

Answer 23

80% response rate, median survival is 8 weeks without and 8 months with treatment, complete remission in 30%

Question 24

Side effects of chemo

Answer 24

Marrow suppression, nausea, mucositis, fatigue, neuropathy, increased MI/stroke, renal impairment, hair loss and nail changes

Question 25

Side effects of radiotherapy

Answer 25

Lethargy, risk to surrounding organs, pneumonitis, dysphagia (swalllowing difficulty), fibrosis, MI risk

Question 26

Side effects of immunotherapy

Answer 26

Anything itis eg colitis

Question 27

Lung cancer screening

Answer 27

Coming up, combines with smoking cessation interventions