Onco - Tx Lung CA SCLC

Question 1

True about SCLC EXCEPT

a. Surgical resection is routinely recommended in patients with LD SCLC
b. Surgical resection of stage I disease, platinum-based adjuvant chemo is given
c. If histologic diagnosis of SCLC is made in patients on review of a resected surgical specimen should receive standard chemotherapy
d. Chemotherapy does not significantly prolong survival

Answer 1

A; not routinely recommended. EXCEPT in Stage I disease

Question 2

True about Chemotx in SCLC

a. Chemotherapy significantly prolongs survival in patients with SCLC
b. cyclophosphamide, doxorubicin and vincristine are first line treatments.
c. patients who relapse within the forst 90 days of therapy are said to have chemoresistant disease
d. a and b
e. a and c

Answer 2

E;

cyclo[hosphamide, doxorubicin and vincristine are alternatives

Question 3

Mainstay treatment for SCLC chemo

Answer 3

4-6 cycles of platinum-based chemotherapy with either cisplatin or carboplatin plus either etoposide or irinotecan

Question 4

SCLC chemo response rate

Answer 4

80%

Question 5

SCLC chemo median survival in LD

Answer 5

12-20 mos

Question 6

SCLC chemo median survival in ED

Answer 6

7-11 mos

Question 7

Patients are said to have sensitive disease if the relapse when?

Answer 7

more than 3 months after initial therapy

Question 8

The only FDA-approved agent for second line therapy in patients with SCLC

Answer 8

topotecan

Question 9

Meaning of refractory SCLC

Answer 9

if there’s progression during first-line therapy

Question 10

Management for refractory SCLC

Answer 10

consider palliative radiotherapy or clinical trial

Question 11

Management for resistant SCLC

Answer 11

topotecan or CAV or clinical trial

Question 12

Management of sensitive SCLC

Answer 12

rechallenge with first line chemotherapy regimen

Question 13

True about radiation therapy except

a. thoracic radiation therapy (TRT) is a standard component of induction therapy for good performance status and limited stage SCLC
b. Chemotx +irradiation improves 3 years survival by 5% as compared with chemotx alone
c. 5 year survival rate is 10-15% after TRT
d. concurrent chemoradiotherapy is equally effective as sequential chemo

Answer 13

D

Question 14

standard regimen for LD SCLC

Answer 14

45Gy dose administered in 1.5Gy fractions twice daily for 30 days

Question 15

T/F prophylactic cranial irradiation should be considered in all patients with either LD-SCLC or ED SCLC who have responded well to initial therapy

Answer 15

T

Question 16

Treatment for squamous LC PD-L>= 50%

Answer 16

Pembrolizumab

Question 17

Treatment for squamous LC PDL< 50%

Answer 17

Platinum-based chemotherapy with gemcitabine or docetaxel or paclitaxel or nab-paclitaxel

Question 18

Treatment for EGFR positive nonsqamous LC

Answer 18

erlotinib
afatinib
gefitinib

Question 19

Treatment for ALK or ROS1 positive nonsqamous LC

Answer 19

crizotinib

Question 20

PD-L1>=50% and EGFR and ALK neg nonsqamous LC

Answer 20

Pembrolizumab

Question 21

PD-L1 <50%% and EGFR, ALK, ROS1 neg

Answer 21

platinum based chemotherapy with pemetrexed or paclitaxel +/- bevacizumab or dcetaxel or nab-paclitaxel