Oncology - Lung Cancer Targeted Therapies Flashcards
EGFR is associated with:
Female
Asian
Never smoked
Adenocarcinoma
EGFR inhibitors:
What are they called and how do they work?
GEFITINIB and ERLOTINIB
Inhibit tyrosine kinase INTRACELLULAR domain of EGFR
Side effects of EGFR inhibitors
- Acneform skin rash (responds to doxycycline and steroids)
- diarrhoea
- pneumonitis
What features increase the likelihood of an ALK mutation?
Adenocarcinoma (present in 4%)
Younger
Minimal smoking hx
Signet ring or mucinous cribeiform mutation
ALK inhibitors:
What is the name?
How does it work?
Side effects?
Crizotinib
Oral tyrosine kinase inhibitor against intracellular domain of ALK
Side effects;
- visual disturbance (70%) with flashing lights, floaters and shadows
- diarrhoea and pneumonitis
- transaminitis
- cardiac: bradycardia, QT prolongation
Which lung Ca is ROS-1 fusion mutation seen in?
Who is it more common in?
What drug can it respond to?
ROS-1 fusion seen in 2% Adenocarcinoma
More common in YOUNGER and NONSMOKER
Also respond to Crizotinib
How does CTLA4 work?
CTLA4 competitively binds to B7 with higher avidity than CD28
–> turns off activated T cells and dampens down the immune response
Which lung cancer treatment drug is an CTLA4 inhibitor?
Ipilimumab
What are the PD1 inhibitors in lung cancer treatment and which one is PDL1 INDEPENDENT?
Nivolumab and Pembro
Nivolumab benefit is independent of PDL1 status
TTF-1 and p40 in differentiating lung cancer type
thyroid transcription factor 1 (TTF-1) in ADENOCARCINOMA
(Also is a positive prognostic factor)
(Also seen in some SCC
p40 is in squamous cell carcinoma
Bevacizumab?
Which lung cancer is it contraindicated in?
VEGF inhibitor
Contraindicated in squamous cell carcinoma and also in haemoptysis (due to increased bleeding risk)
