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Oncology boards > NSCLC > Flashcards

NSCLC Flashcards

1
Q

Second line for NSCLC

A

docetaxel +/- ramucirumab

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2
Q

First line for BRAF mutant NSCLC

A

BRAF/MEK

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3
Q

First line for RET mutant NSCLC

A

RET inhibitors - Selpercatinib (Libretto 431) + pralsetinib

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4
Q

First line for MET mutant NSCLC

A

MET inhibitors - capmatinib vs. tepotinib

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5
Q

Osimertinib SE’s

A

cardiomyopathy
long QT syndrome

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6
Q

amivantimab targets?

A

EGFR + MET

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7
Q

First line ALK targeted therapies

A

alectinib
brigatinib
Lorlatinib
*Ceritinib (not preferred but also category 1)
*crizotinib (not preferred but also category 1)

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8
Q

Class effect ALK inhibitor SE’s to know

A

bradycardia
pneumonitis

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9
Q

Drugs targeted ROS1

A

Crizotinib
entrectinib
repotrectinib

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10
Q

crizotinib SE’s to know

A
  • visual dysfunction
  • hepatotoxicity
  • low testosterone
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11
Q

RET fusion targeting drugs

A

selpercatinib
pralsetinib

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12
Q

Drugs targeting MET

A

tepotinib
capmatinib
Amivantimab

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13
Q

Class effect of MET inhibitors to know

A
  • peripheral edema
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14
Q

NTRK targeting drugs

A

entrectinib
lorlectinib

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15
Q

KRAS g12c targeting drugs

A

Sotorasib
Adagrasib

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16
Q

First line for KRAS

A

Chemoimmunotherapy

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17
Q

Line of therapy for which HER2 is approved in NSCLC

A

second line or subsequent

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18
Q

Stains for adeno

A

***CK7
Napsin A
TTF1

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19
Q

CK20 positive suggests what tissue origin

A

GI tract primary

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20
Q

T3 NSCLC

A

1)Tumor >5 cm but ≤7 cm in greatest dimension
2)or associated with separate tumor nodule(s) in the same lobe as the primary tumor
3) or directly invades any of the following structures: chest wall (including the parietal pleura and superior sulcus tumors), phrenic nerve, parietal pericardium

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21
Q

T2 NSCLC

A

1)Tumor >3 cm but ≤5 cm
2)or tumor with any of the following features:Δ
Involves main bronchus regardless of distance from the carina but without involvement of the carina
Invades visceral pleura
3)Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, involving part or all of the lung

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22
Q

T staging that indicates adjuvant chemo

A

Greater than 4 cm is T2b

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23
Q

N3 disease

A

Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

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24
Q

N2 disease

A

Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)

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25
Q

N1 disease

A

Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension

26
Q

IA vs. IB

A

T2 qualifies as IB
*Important since changes management

27
Q

Adjuvant immunotherapy indication

A
  • atezo if PD-L1 positive
  • pembro regardless (approval, but benefit unknown)
28
Q

ALK drug studied in Alina for adjuvant of ALK mutant NSCLC

A

Alectinib

29
Q

Necessary FEV1 post-op for determining surgical candidacy

A

1.5L for lobectomy
Greater than 2L for pneumonectomy
*board question may state this and answer will be radiation over surgery

30
Q

Management of unresectable superior sulcus tumor

A

Chemoradiation followed by adjuvant durvalumab

31
Q

typical first line regimen for squamous and nonsquamous

A

adeno - carbo/pem/pem
squam - carbo/taxol/pembro

32
Q

adeno stains

A

CK7
TTF1

33
Q

squam stains

A

P63
P40
TTF1 negative
*impt to know since may just give stains

34
Q

Concurrent chemoradiation regimens for 1) nonsquamous 2) squamous

A

Nonsquamous:
- carbo/pem
- cis/pem
- carbo/taxol
Squamous:
- carbo/taxol
- cisplatin/etoposide

35
Q

Nonresectable superior sulcus tumor management

A

Definitive CRT followed by durvalumab

36
Q

Board answer to patient to CR to pembro and NED at 2 years

A

Stop treatment

37
Q

Management of oligometastatic NSCLC with PR

A

Local therapy (XRT) to sites of residual disease

38
Q

Indication for adjuvant immunotherapy

A
  • same as for chemo (tumors of 4 cm or larger)
39
Q

Indication for adjuvant atezo

A
  • Stage II-IIIA
  • PDL1 greater than 1%
40
Q

Answer to adjuvant for visceral pleural invasion on boards

A

If multiple high risk features (poorly differentiated, vascular invasion, wedge resection, visceral pleural invasion, unknown nodal status), give adjuvant cehmo

41
Q

Approved line of therapy for KRAS targeted therapy

A

Second line

42
Q

Second line for small cell

A

*REMEMBER, depends on platinum sensitivity (relapse after 3-6 months considered platinum sensitive)

43
Q

Line of therapy for RET in solid tumor

A
  • second line or later for any solid tumor (tissue agnostic)
44
Q

Line of therapy for RET targeted therapy

A

Firstline

45
Q

Indication for lung cancer screening

A
  • age 50-85
  • 20 pack-year smoking history
  • currently smoke or have quit within 15 years
46
Q

Standard radiation dose for NSCLC CRT

A

60 Gy

47
Q

EGFR exon 20 drugs approved for second line

A

*Mobicertinib
Amivantamab

48
Q

Management of localized sarcomatoid mesothelioma

A

Ipi/nivo
*No surgical cytoreduction (aggressive disease biology)

49
Q

Characteristics of malignant pleural effusion per Light certiera

A
  • pleural fluid protein to serum protein ratio >0.5
  • pleural fluid LDH to serum LDH >0.6
  • OR pleural fluid LDH > 2/3’s of ULN of serum LDH
    *rapid recurrence
50
Q

CrCl threshold for pemetrexed

A

CrCl>45

51
Q

Staging of thymoma

A

Stage 1 - completely encapsulated
Stage 2 - transcapsular invasion and/or extension to surrounding tissue
Stage 3 - Extension to neighboring organ
Stage 4 - pleural, pericardial, lymphogenous, hematogenous dissemination

52
Q

First line for metastatic thymoma

A

cisplatin, doxorubin, cyclophosphamide, and prednisone for 6 cycles

53
Q

Management of grade 1 mucositis per boards

A

“sodium bicarbonate mouthwash with local anesthetics and antiulcer medication”

54
Q

First line options for epitheliod mesothelioma

A
  • nivo/ipi
  • platinum/pemetrexed +/- bev
55
Q

Most common SE of selpercatinib + second most common

A

1) HTN most commonly
2) Elevated liver enzymes

56
Q

CNS activity of ROS1 TKI’s

A
  • entrectinib and repotrectinib have good CNS activity
57
Q

Line of therapy for ROS1 TKI’s

A

First line

58
Q

First line for thymic carcinoma

A

carbo/taxol

59
Q

Stage IIIB requires

A

T3-4 N2 OR N3 disease

60
Q

Second line for thymoma

A

Pemetrexed

61
Q

How is cervical adenopathy staged in NSCLC?

A

M1

62
Q

Other high emetic risk drugs

A
  • ACT
  • carbo AUC >4
  • cytoxan >1500
  • dacarbazine
  • TDxd
  • ifosfamide
  • melphalaen
  • sacituzumab

Oncology boards (41 decks)

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