Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hematology, oncology > NSCLC > Flashcards

NSCLC Flashcards

1
Q

2 most common mutations in NSCLC

A

p53 and KRAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how does smoking induce carcinogenesis

A

hydrocarbins and nitrosamines form DNA adducts by covalently binding to DNA, resulting in DNA misreplication and mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

effect of screening for lung cancer

A

20% decrease in lung-cancer-specific mortality in this population, 7% decreased in overall mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

who should be screened for lung cancer

A

current smokers or smokers who quit within the last 15 years. 55-77.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Subtypes of NSCLC

A

1) adenocarcinoma
2) squamous cell carcinoma
3) *large cell undifferentiated carcinoma
4) mixed histology tumors (eg. adenosquamous carcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

paraneoplastic syndromes associated with NSCLC

A

1) Humoral hypercalcemia (pTHRP)
2) Hypercoagulable state (Trousseau syndrome)
3) Hypertrophic pulmonary osteoarthropathy (HPOA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

most critical decision making point during workup of NSCLC

A

presence or absence of sites of disease that would preclude primary surgery or cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

variables precluding surgery/cure

A

malignant effusion
distant mets
chest wall invasion
***N2 or N3 lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

negative prognostic markers in NSCLC

A

K-RAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

positive prognostic markers in NSCLC

A

EGFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

intent of therapy for stages I-III

A

cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

system for determining completeness of resection

A

R0 = complete
R1 = microscopic residual disease (positive margins)
R2 = macroscopic (gross) residual disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

surgical options

A

lobectomy, pneumonectomy, sublobar resection (wedge resection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

stage I management

A

Refer to CT surgery + preoperative PFTs
IF surgical candidate → Complete surgical resection
No role for adjuvant chemotherapy unless high risk with tumor diameter >4 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

clinical features of stage III criteria

A

1) nodal involvement – N2 or N3 disease
2) Size – greater than 7 cm with or without nodal involvement
- greater than 5 cm with nodal involvement
3) some other criteria…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

options for management of positive margins post-op

A

1) re-resect if possible
2) RT if re-resection not possible
3) concurrent chemo plus RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

regimens for use with concurrent RT

A

PLATINUM DOUBLETS
cisplatin + etoposide
carboplatin + etoposide
carboplatin + paclitaxel
Cisplatin/carboplatin + pemetrexed (adenocarcinoma only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

EGFR TKIs

A
  • osimertinib
  • erlotinib
  • gefitinib
  • afatinib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

drug targeting ALK and ROS1

A

crizotinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

difference between nivolumab and pembrolizumab for NSCLC

A
  • pembro is only approved for tumors that express PD-L1 >1%
  • nivo doesn’t require PD-L1 testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

alimta generic name

A

pemetrexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

EGFR TKI’s

A

5 FDA approved: osimertinib, erlotinib, gefitinib, afatinib, dacomitinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Major risk factors for non-small cell lung cancer

A

smoking, radon, asbestos, COPD,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prevalence of sensitizing EGFR mutations?

A

10% in Western populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

evidence for beta-carotene in preventing lung cancer in current smokers

A

None, increased incidence of lung cancer in RCTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

First diagnostic step in patient with incidentally found solitary pulmonary node?

A

review of prior chest imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clinical significance of ERCC1 biomarker

A

High expression = Resistance to platinum agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Clinical significance of RRM1 biomarker

A

High expression = resistance to gemcitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Clinical significance of K-RAS mutation

A

confers resistance to EGFR-TKIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

when do you need to test for EGFR, ALK, ROS1?

A

Stage IV adeno or squamous if mixed histology or neversmoker (very low likelihood of finding in squamous)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Targets tested for in molecular testing

A

driver mutations (EGFR, ALK, ROS1, BRAF) + assess PDL1 expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

types of surgery

A

Lobectomy/pneumonectomy
sublobar resection/wedge resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

options for early stage NSCLC who are inoperable

A

SBRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Stage II management

A

IF II or IB → surgery with adjuvant chemo
IF nonsurgical candidate → RT, SABR, or RFA w/ curative intent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Management of superior sulcus (pancoast tumors) stage IIB + A

A

Neoadjuvant concurrent chemo plus RT followed by resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is PCI?

A

prophylactic cranial irradiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of stage IV NSCLC?

A

IF PS1-2: Targeted therapy if actionable mutation or immunotherapy
IF PS3-4: Palliative care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management of solitary FDG-PET avid lymph nod in addition to mass

A

Biopsy – would preclude surgery, thus needs to be biopsied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Treatment of tumor harboring EGFR sensitizing mutation

A

EGFR-TKI’s (erlotinib, gefinitib, afatinib)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Treatment of tumor that is driver mutation negative, PD-L1 positive

A

Pembrolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

adjuvant chemo regimens in general

A

Platinum doublets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

cisplatin vs carboplatin efficacy and toxicity

A

equivalent efficacy, but carbo is less toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Drugs not used with squamous cell histology + why

A
  • Pemetrexed not indicated (lack of efficacy)
  • Bevacizumab shouldn’t be used (excessive risk of hemoptysis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Treatment of Stage III in general

A

*most = concurrent CRT followed by durvalumab
*select patients considered for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Chest CT type

A

noncontrast adequate if tumor only involves lung parenchyma, need contrast if meldiastinal or other nodal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

difference in treatment between adeno and squamous

A

pemetrexed not used for squamous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Molecular targets tested for

A

ALK/elk
C-ros1/Ross riding elk
EGFR/vegetable garden
BRAF/Brad getting f’d by horse
PD-L1
MET
*RET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

First step if spiculated nodule post op

A

PET/CT
Talk to IR about biopsing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

When is molecular testing indicated in NSCLC

A

Stage IV, adeno, or squamous if mixed histology or never smoker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

N3 disease in NSCLC

A

lymph node involvement in side contralateral to tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is a platinum doublet?

A

carboplatin or cisplatin plus paclitaxel, docetaxel, pemetrexed, or gemcitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Positive prognostic biomarker in NSCLC

A

KRAS (wild type have longer survival)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

BRAF mutation prevalence

A

rare, 1-2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

BRAF mutation clinical implications

A

1) sensitive to BRAF inhibitors
2) ***modest response to CPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Prevalence of ROS1 rearrangements

A

rare, 1-2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

clinical implications of ALK rearrangement

A

sensitive to ALK TKIs and *resistant to EGFR TKIS and CPIs
(ALK and EGFR are mutually exclusive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

General efficacy of targeted therapy in NSCLC

A

useful in a very low percentage of overall patients with lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

molecular testing used to predict EGFR TKI response

A

POINT MUTATIONS, not EGFR expression via IHC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Treatment for metastatic NSCLC unresponsive to platinum-based therapy without driver mtuation

A

IO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Contraindications to surgery with Stage III

A
  • Mediastinal involvement (confirm)
  • Bulky multistation lymphadenopathy (widespread mediastinal or hilar lymph node involvement)
  • chest wall invasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

When to test for activating mutations

A

Metastatic adeno (can test in squamous, but likelihood of finding an alteration is very low)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

more common histology

A

adeno

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

adjuvant management of stage II

A

adjuvant platinum doublet chemo, NO radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Stage III management

A

chemoradiation (does not typically fare well with surgery, mediastinal involvement…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Stage I criteria

A
  • No nodal involvement
  • tumor 4cm or smaller
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Definition of stage II (some exceptions) =

A
  • Peribronchial or perihilar lymph node involvement
  • OR larger tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Stage III Generally (some exceptions) means

A

Mediastinal or supraclavicular nodal involvement OR large size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Stage I treatment generally

A

Gold standard is lobectomy, no adjuvant chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Management of Stage I patient who defers surgery or who is not surgical candidate?

A

SBRT (similar outcomes to surgery have been shown in trials) OR wedge resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Only patients who seem to benefit from adjuvant chemo in stage I

A

Highly select Stage IB patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Stage II treatment generally

A

Surgery with adjuvant chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Standard chemo for adjuvant treatment in general

A

Cisplatin-doublets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Standard chemo regimen for squamous cell histology NSCLC

A

Cisplatin + gemcitabine or docetaxel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Stage IIIA treatment generally

A
  • IF surgical candidate and operable – chemo or CRT followed by surgery
  • IF nonsurgical candidate – CRT followed by durvalumab consolidation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Stage IIIB treatment generally

A

CRT or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Other contraindications for surgery

A
  • Hoarse voice or elevated hemi-diaphragm
    **most importantly – Inadequate cardiopulmonary reserve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Definition of adequate cardiopulmonary reserve in PFTs

A
  • FEV 1 greater than 1.5 L (pre-op) for lobectomy
  • FEV 1 greater than 2 L (pre-op) for pneumonectomy
  • Goal is to have greater than 40% post-op predicted for FEV-1 and DLCO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

N2 vs N1 lymph nodes in terms of digits

A
  • Single digit LN’s are N2
  • Double digit LN’s are N1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

N1 refers to

A

peribronchial or perihilar lymph nodes (confirm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Alternative options for lobectomy if medically inoperable

A

SBRT or wedge resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Area that is critical for staging

A

Mediastinal staging (assessing for multilevel disease, contralateral disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Pemetrexed is only used for

A

Non-squamous histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Role for post-operative radiation therapy in Stage II

A
  • small OS benefit in IIA (N2) disease
    *so refer these patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Role for immunotherapy

A

1) induction, consolidation
2) Now promising data of immunotherapy in neoadjuvant setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Management of Superior sulcus tumor

A

Neoadjuvant CRT, then proceed to surgery then adjuvant chemo
*local control is critical to reducing morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Superior sulcus tumor presentation

A

Typically describe upper neck or shoulder pain

87
Q

Management of chest wall invasion

A

ChemoRT

88
Q

Who to not do surgery on in Stage III

A
  • significant weight loss or PS 2 or greater
  • borderline cardio-respiratory status
  • multi-level N2 disease
  • IF requiring pneumonectomy, should be more conservative
89
Q

Management of unresectable stage III

A
  • Concurrent CRT followed by durvalumab
90
Q

Initial workup of stage IVA

A
  • molecular testing (adeno)
  • MRI
  • PETCT
91
Q

Management of brain mets in NSCLC

A

Stereotactic radiosurgery (SRS) alone
OR
surgical resection followed by WBRT

92
Q

PD-L1 TPS stands for

A

PD-L1 tumor proportion score

93
Q

What is concept of continuation maintenance?

A

Continuing the same drug as you gave in induction chemo as the maintenance drug

94
Q

What is concept of switch maintenance?

A

Switching to a new drug for maintenance treatment

95
Q

Role for chemo in stage IV

A

PS1-2 patients who no targetable mutations and ineligible for IO therapy

96
Q

BSC is

A

best supportive care

97
Q

PD means

A

progressive disease

98
Q

Basic algorithm for management of non-squamous stage IV NSCLC

A

Targeted therapy if actionable mutation
IF no targetable mutation –> immunotherapy
IF no targetable mutation and contraindications to IO –> BEV (bevacizumab)

99
Q

Role for targeted therapy in stage IV adeno

A
  • EGFR and ALK inhibitors are first approved for first line
  • Ros-1, BRAF, MET, and RET are approved for second LINE
100
Q

Standard of care EGFR TKI for exon 19 mutation

A

osimertinib

101
Q

Most commonly found targetable mutations

A

ALK and EGFR

102
Q

Approved ALK inhibitors in first line setting

A
  • Crizotinib
  • Ceritinib
  • Brigatinib
  • Alectinib
  • a few others
103
Q

superior/first line ALK inhibitors

A

Alectinib
Brigatinib

104
Q

Clinical utility of targeting other mutations at this point

A

There are FDA approved drugs but there is no clear consensus on which line of therapy to use these agents.(but a lot of experts use them in the first line setting if patient has a targetable mutation).

105
Q

Drugs targeting ROS-1

A

Crizotinib
Entrectinib
Lorlatinib

106
Q

Drug targeting RET fusion

A

Selpercatinib

107
Q

Drug targeting MET exon 14 splice mutation

A

Capmatinib

108
Q

First line for patients with metastatic NSCLC and no actionable mutation

A

Depends on PDL1 status

109
Q

Immunotherapy drugs approved for NSCLC

A

Nivo (regardless of PD-L1)
Pembro (only if PDL-1 greater than 1%)
Atezolizumab (regardless of PD-L1)
Darvalumab

110
Q

Correlation of PD-L1 and immunotherapy in NSCLC

A

Higher the PD-L1 score, the higher the likelihood of response (also holds for tumor mutational burden)

111
Q

Duration of immunotherapy in advanced NSCLC

A
  • up to 2 years
112
Q

TPS vs CPS

A

CPS = number of PD-L1 positive TUMOR cells over viable tumor cells
TPS = number of PD-L1 positive TOTAL cells (including tumor cells, lymphocytes, macrophages) over viable tumor cells

113
Q

KRAS drug

A

sotorasib

114
Q

Stage IA management

A
  • surgery alone, no adjuvant chemo
115
Q

oligometastatic disease management with 1-3 brain mets

A
  • SRS or surgery to brain met followed by definitive chemoRT (these patients can have long term survival)
116
Q

First line for patient with advanced NSCLC and an ALK-EML4 rearrangement

A

ALK inhibitor

117
Q

Characteristics of patients with ALK mutations

A
  • young
  • never-smokers
  • adeno histology
  • *mutually exclusive to having an EGFR mutation
118
Q

crizotinib molecular targets

A

ALK + ROS1 + MET (multikinase inhibitor)

119
Q

Drugs approved for ROS-1 mutations

A
  • crizotinib
  • entrectinib
    Lorlatinib
120
Q

Line of therapy of ALK inhibitors for stage IV + CNS penetration

A
  • first line
  • alectinib, brigatinib, lorlatinib
  • good CNS penetration
121
Q

adjuvant chemo in general for stage II-III + number of cycles

A

Cisplatin-based doublet for 4 cycles

122
Q

T3 NSCLC means (in terms of tumor burden)

A
  • separate nodule in primary lobe
123
Q

T4 NSCLC means

A
  • Tumor >7 cm in greatest dimension
  • or associated with separate tumor nodule(s) in a different IPSILATERAL lobe than that of the primary tumor
  • or invades any of the following structures: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, and carina
124
Q

M1a means

A
  • nodule in a contralateral lung (make sure not a different primary)
125
Q

Stage IIIC lung adeno management and regimen

A

IF nodal –> chemoRT with platinum doublet followed by consolidation with durvalumab
IF T4NO – primary surgery

126
Q

staging significance of contralateral mediastinal or hilar lymphadenopathy

A

N3 disease

127
Q

Stage III management in patient with EGFR mutation

A

chemoRT adjuvant osimertinib

128
Q

approved EGFR targeted therapies

A
  • erlotinib + minus ramucirumab
  • osimertinib
  • gefitinib
  • afatinib
  • dacomitinib
    *there are a bunch but osimertinib is preferred per NCCN
129
Q

efficacy of immunotherapy in patients with actionable mutation

A

generally doesn’t work well

130
Q

Initial step in management of progression on EGFR targeted therapy

A

Given disease progression, will repeat biopsy with sequencing + continue osimertinib
*unless concern for visceral crisis, then carbo + pemetrexed

131
Q

afatinib targets

A

EGFR + HER2 TKI

132
Q

Drugs that are only indicated for non-squamous histology

A

1) bev (CONFIRM)
2) pemetrexed

133
Q

pancoast tumor management

A
  • pre-operative chemorads, followed by surgery, with adjuvant chemo
134
Q

presentation of pancoast tumors

A
  • severe shoulder pain
  • hand muscle atrophy
  • subclavian vein obstruction
  • horner’s syndrome
135
Q

Drug to avoid in second line setting for patients with actionable mutations

A
  • immune checkpoint inhibitors
    (this cohort fails to respond to immunotherapy for unclear reasons) (PD-1/PD-L1 is probably not the main escape route for this tumor type)
136
Q

FDA approved drugs for patients with MET amplification

A
  • crizotinib, capmatinib, tepotinib
137
Q

Activity of ALK inhibitors

A
  • very active in advanced NSCLC but still only approved for stage IV setting
138
Q

Only situations in which wedge resection is preferred over lobectomy

A

1) poor pulmonary reserve or other comorbidity contraindicating lobectomy
2) **peripheral* nodule less than 2 cm with at least one of the following: Pure AIS histology, Nodule greater than 50% GGO on CT, or surveillance confirms a long doubling time
*just remember lobectomy done most of the time. Wedge resection has worse outcomes.

139
Q

SE to know about with crizotinib

A
  • hypogonadism
140
Q

Preferred chemo regimens to give concurrently with radiation for Stage III squamous

A

1) weekly taxol and carboplatin
2) cisplatin/etoposide

141
Q

Creatinine clearance that is contraindication for pemetrexed

A

less than 45 ml/min

142
Q

regimen and number of cycles for extensive stage SCLC

A

4 cycles of carbo + etoposide with atezo **OR durvalumab maintenance

143
Q

next step after finishing 6 cycles of carbo-etoposide for SCLC

A

Stop therapy and then let patient recover, rechallenge when cancer recurs

144
Q

management of grade 1 pneumonitis from checkpoint inhibitors

A
  • hold immunotherapy and reassess in 1-2 weeks
145
Q

management of grade 2 pneumonitis from checkpoint inhibitors

A
  • hold treatment, consult pulm, ID work-up, start steroids
146
Q

most commonly observed genetic alterations in patients with EGFR resistance

A
  • MET amplification
  • C797S
147
Q

Regimens approved for Stage IV lung adeno without actionable mutation

A
  • carbo - pemetrexed + pembro
  • carbo + taxol + bev + atezo
  • carbo + abraxane + atezo
  • nivo + ipi + pemetrexed + carbo
  • nivo + ipi
  • pembro monotherapy
148
Q

second line for metastatic lung adeno EGFR+

A

IMpower 150

149
Q

Stage III NSCLC management

A

chemorads followed by darvalumab consolidation

150
Q

first line regimen for metastatic squamous cell lung cancer with 0% PDL1

A

pembro + carbo + taxol (or albumin-bound paclitaxel

151
Q

PD-L1 level required for frontline pembro + carbo + taxol for stage IV squamous cell lung cancer

A

agnostic (doesn’t matter)

152
Q

PD-L1 level required for second line immunotherapy in stage IV squamous cell lung cancer

A

pembro = 1%
others (nivo and atezo) are agnostic

153
Q

first line ALK inhibitors + preferred ALK inhibitor + why preferred

A

alectinib (preferred given improved CNS penetration, and well tolerated)
brigatinib
lorlatinib

154
Q

second line for ALK positive NSCLC

A
  • switch to different ALK inhibitor (depends on what was previously received, active against resistant mechanisms)
  • if started on crizotinib, switch to alectinib, brigatinib, or ceritinib
  • if started on alectinib, brigatinib, ceritinib, or lorlatinib, offer lorlatinib (active against resistant mechanisms)
155
Q

role for sotorasib (KRAS inhibitor)

A
  • Second line for metastaic, previously treated with chemo (may change, trial in a few years)
156
Q

Targeted therapy for BRAF mutant? line of therapy?

A
  • combination BRAF/MEK (dabrafenib-trametinib)
  • first line
157
Q

biggest SE of MET inhibitors

A

peripheral edema

158
Q

CNS penetration of targeted therapy generally speaking

A

Most have CNS penetration

159
Q

KRAS targetable mutation

A

p.G12C

160
Q

Response rate required for first line FDA approval

A

Response rate greater than 50%

161
Q

abraxane vs. paclitaxel in terms of SE profile + action

A
  • less neuropathy
  • some evidence abraxane gets into tumor cells better
162
Q

What is IMpower150 regimen

A

atezo + bev + taxol + carbo

163
Q

ChemoRT regimens for Stage III

A

1) cisplatin + etoposide, followed by durvalumab
2) carbo/taxol

164
Q

Management of stage II patient who is status post resection with R1 resection

A
  • reresection if surgical candidate
  • if not surgical candidate, then sequential or concurrent chemoRT
165
Q

General treatment approach for superior sulcus or pancoast tumor

A

**neoadjuvant chemoradiation –> surgery –> adjuvant chemo

166
Q

Preferred maintenance IO for carbo/etoposide in SCLC

A

Atezo or durvalumab

167
Q

Role for EGFR TKI’s

A

1) Stage IV disease
2) Adjuvant setting

168
Q

immunotherapy used as consolidation for stage III NSCLC after chemoRT

A

durvalumab

169
Q

Diagnosis of pulmonary osteoarthropathy

A
  • bone scan (highly sensitive). Shows diffuse, symmetrically increased uptake in diaphysis and metaphysis of tubular bone.
170
Q

Most common lung cancer histologic subtype in non-smokers

A

invasive mucinous adenocarcinoma

171
Q

Procedure used for mediastinal staging

A

Mediastinoscopy

172
Q

Other drug you can’t give to squamous histology

A

Bev

173
Q

KRAS line approval

A

Second line

174
Q

Difference m

A

.

175
Q

Drug approved for EXON 20 EGFR + line of therapy

A
  • mobocertinib
  • second line
176
Q

Segmentectomy

A
  • removal of part of one of the lobes of the lung
  • Segmentectomy may be recommended over lobectomy (where one entire lobe of the lung is removed) if the patient already has a highly reduced lung reserve. Lobectomy is the most common and preferred type of procedure for NSCLC.
177
Q

Size threshold for wedge resection

A

Less than 4 cm

178
Q

Why never give IO second line for targeted mutations?

A
  • won’t respond
  • substantially increases risk of toxicity
179
Q

NTRK mutation is druggable in which cancers

A

ALL, universally responsive

180
Q

Only ALK inhibitor with an indication for ROS1

A

crizotinib

181
Q

Management of R1 resection in NSCLC

A

CRT

182
Q

Promising investigational approach to Stage III lung

A

Chemoimmunotherapy induction

183
Q

High risk factors warranting adjuvant chemotherapy for stage I

A

tumor >4cm

184
Q

Resistance mechanism to first and second generation EGFR TKI’s that led to development of osimertinib

A

T790 in exon 20

185
Q

Drug approved for EGFR insertion 20 mutations + in what line

A

Mobicertinib, second line

186
Q

Category 1 NCCN regimens for squamous and non squamous metastatic

A

squamous — carbo, taxol, pembro
nonsquamous – carbo, pem, pem

187
Q

N2 disease is

A

Ipsilateral mediastinal OR subcarinal lymph node (confirm)

188
Q

management of ILD from osimertinib

A
  • stop osimertinib
  • start steroids
189
Q

IHC as good as a test as FISH for ALK

A

equivalent

190
Q

First line for ROS1 mutant

A

entrectinib

191
Q

adjuvant therapy for Stage II to IIIA

A

chemo for high risk features
atezo for 1 year if PD-L1 greater than 1%
***confirm this

192
Q

Second line for stage IV adeno with excellent PS

A

ramucirumab + docetaxel

193
Q

What is stage 1a in terms of disease burden?

A

no lymph node involvement

194
Q

NCCN preferred first line for metastatic thymic carcinoma

A

Carboplatin/paclitaxel

195
Q

lung cancer screening indication

A

IF 50-80 w/ 15 pack yr history AND current or quit <15 yrs ago, annual Low-dose chest CT

196
Q

Platinum doublet adjuvant regimens

A

gemcitabine
docetaxel
vinorelbine.
IF nonsquamous -> pemetrexed

197
Q

Neoadjuvant chemo approved for what indications?

A

N1 OR >4 cm

198
Q

ROS-1 drugs

A

entrectinib
crizotinib

199
Q

High risk features warranting adjuvant treatment

A

tumor >4 cm

200
Q

Size at which you can’t do SRS alone in NSCLC

A

At a certain size threshold (?) you need conventionally fractioned radiation rather than SRS, which requires chemo for local control

201
Q

T3 disease in 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

202
Q

T4 disease

A

1) Tumor >7 cm in greatest dimension
2) or associated with separate tumor nodule(s) in a different IPSILATERAL lobe than that of the primary tumor
3) OR invades any of the following: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, and carina

203
Q

Clinical significance of separate tumor nodule in contralateral lobe

A

M1a disease

204
Q

Indications for molecular lung panel

A

Given adeno OR squamous neversmoker (or light smoker) OR mixed histology, molecular lung panel

205
Q

What is ALCHEMIST looking at?

A
  • early stage with druggable mutations
  • Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials – represents three integrated, precision medicine trials that are designed to identify people with early-stage lung cancer who have tumors that harbor EGFR and ALK gene alterations and evaluate whether drug treatments targeted against those molecular changes can lead to improved survival compared to current standard of care therapy alone
206
Q

What are the sublobar surgery types?

A

Segmentectomy – removes larger piece of lung tissue
Wedge resection –

207
Q

What is a pneumonectomy?

A

Removal of entire lung

208
Q

Separate tumor nodule in a contralateral lobe indicates

A

M1a disease

209
Q

Which number lymph node stations are N1 disease?

A

10-13

210
Q

Which number lymph node stations are N2-3 disease?

A

1-9

211
Q

T staging of satelite lesions

A

T3 = same ipsilateral lobe
T4 = different ipsilateral lobe

212
Q

Term for response rate of CNS disease

A

Intracranial response rate

213
Q

What are the types of sublobar resections?

A

1) segmentectomy 2) wedge

Hematology, oncology (218 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions