Therapeutics of Lung Cancer (Weddle) Flashcards
What is the most effective screening tool for lung cancer?
low-dose CT scan
What frequency of lung cancer screening is recommended for asymptomatic adults age 50-80 with a 20 pack year history or who have quit within the last 15 years?
annually
EGFR mutations can predict sensitivity to ________.
TKIs
______ mutations can predict resistance to TKIs.
KRAS
True or false: BRAFV600E should be tested for in NSCLC and SCLC.
false; just NSCLC
Patients with EGFR mutations, ALK, or ROS-1 rearrangements typically don’t have _____ expression.
PD-1
Which has a clear relationship to smoking: SCLC or NSCLC?
SCLC
In which type of lung cancer are paraneoplastic syndromes common: SCLC or NSCLC?
SCLC
Which is more sensitive to radiation: SCLC or NSCLC?
SCLC
Which has a slower growth fraction: SCLC or NSCLC?
NSCLC
What is the ideal treatment regimen for limited-stage SCLC?
cisplatin + etoposide (EP) AND radiation
What would be an appropriate drug regimen for extensive-stage SCLC?
carboplatin + etoposide + atezolizumab/durvalumab
What drug regimen as studied in the IMpower133 Trial?
atezolizumab + carboplatin + etoposide
What drug regimen was studied in the CASPIAN Trial?
durvalumab + carboplatin + etoposide
What are some common toxicities associated with radiation therapy?
- fatigue
- esophagitis
- pneumonitis
- cardiac toxicity
Is radiation preferred in extensive-stage SCLC?
nope
What are the preferred treatment options for a SCLC relapse in 6 months or less?
- topotecan PO or IV
- lurbinectidin
- clinical trial
What are the preferred treatment options for a SCLC relapse that occurs later than 6 months after treatment?
restart the original regimen
When would you consider using pembrolizumab for SCLC?
metastatic disease that has progressed on or after platinum-based therapy and at least 1 prior line of therapy
How is NSCLC staged?
TNM system
What is the standard of treatment for resectable NSCLC?
surgery + adjuvant chemotherapy
What is the preferred adjuvant chemotherapy for non-squamous NSCLC?
cisplatin + pemetrexed
Give a preferred adjuvant chemotherapy regimen for squamous NSCLC.
- cisplatin + gemcitabine
- cisplatin + docetaxel
(there are other recommended regimens but let’s pretend there aren’t)
What is the standard of therapy for unresectable NSCLC?
chemotherapy + radiation
Which immunotherapy would you use for unresectable, stage III NSCLC with disease that has not progressed following concurrent chemotherapy and radiation therapy (as maintenance)?
durvalumab
What regimen might be used for stage IIIB/IV unresectable NSCLC?
- carboplatin/paclitaxel (fewer toxicities)
- cisplatin/paclitaxel
- cisplatin/docetaxel
- cisplatin/gemcitabine
What drug may be an option for stage III unresectable NSCLC patients who aren’t candidates for surgery or definitive chemotherapy with radiation?
pembrolizumab
What is the 1st line EGFR-targeting therapy for metastatic NSCLC?
osimertinib
What drug can be used against T790M mutations?
osimertinib
What are some common toxicities of osimertinib?
- rash
- diarrhea
- cardiomyopathy
- QTc prolongation
- nail changes
What ALK inhibitor is 1st line for metastatic NSCLC?
alectinib
What toxicities are associated with alectinib?
- muscle pain
- increased LFTs
- edema
- electrolyte abnormalities
- cough
- bradycardia
- N/V
- constipation
- diarrhea
What ROS-1 therapy is 1st line for metastatic NSCLC?
crizotinib
What toxicities are associated with crizotinib?
- edema
- fatigue
- neuropathy
- skin rash
- N/V
- diarrhea
- constipation
- increased LFTs
- visual disturbances
- QTc prolongation
What BRAF therapy is 1st line against metastatic NSCLC?
dabrafenib + trametinib
What toxicities are associated with dabrafenib?
- fevers
- rash
- secondary skin cancers
- hyperglycemia
- visual changes
What toxicities are associated with trametinib?
- fevers
- rash
- hand foot syndrome
- hypertension
- visual changes
- diarrhea
What NTRK gene fusion therapy is 1st line for metastatic NSCLC?
larotrectinib
What toxicities are associated with larotrectinib?
- neurotoxicity
- fatigue
- N/V
- constipation
- diarrhea
- anemia
- increased LFTs
What RET rearrangement therapy is 1st line for metastatic NSCLC?
selpercatinib
What drug class should be avoided with selpercatinib?
PPIs (or give 2 hours before PPI)
What toxicities are associated with selpercatinib?
- edema
- HTN
- rash
- electrolyte abnormalities
- constipation
- diarrhea
- N/V
- fatigue
- increased LFTs
- increased creatinine
- thrombocytopenia
What MET Exon 14 skipping therapy is 1st line for metastatic NSCLC?
capmatinib OR tepotinib
What toxicities are associated with MET Exon 14 therapies?
- edema
- electrolyte changes
- N/V
- lymphocytopenia
- increased LFTs
- fatigue
- increased SCr
What KRAS G12C therapy is 1st line for metastatic NSCLC?
sotorasib
What toxicities are associated with sotorasib?
- N/V
- diarrhea
- increased LFTs
- rash
- edema
- decreased hemoglobin
- pneumonitis
What should be checked if a metastatic NSCLC patient has no mutations, or if targeted oral chemotherapy options have been exhausted for a positive mutation?
PD-L1 (then, could use pembrolizumab)
What oral chemotherapy is recommended for metastatic non-squamous NSCLC patients with 50%+ PD-L1?
cemiplimab-rwlc
What is the preferred drug regimen for metastatic non-squamous NSCLC with no mutations?
carboplatin + pemetrexed + pembrolizumab
What treatment would you recommend for metastatic squamous NSCLC (PD-L1 + PS) with no contraindication for immunotherapy?
pembrolizumab + carboplatin + paclitaxel/nab-paclitaxel
What treatment would you recommend for metastatic squamous NSCLC (PD-L1 + PS) with contraindication to immunotherapy?
platinum doublet regardless of PD-L1 status
