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Fall 2021: Therapeutics III > Therapeutics of Lung Cancer (Weddle) > Flashcards

Therapeutics of Lung Cancer (Weddle) Flashcards

1
Q

What is the most effective screening tool for lung cancer?

A

low-dose CT scan

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2
Q

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?

A

annually

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3
Q

EGFR mutations can predict sensitivity to ________.

A

TKIs

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4
Q

______ mutations can predict resistance to TKIs.

A

KRAS

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5
Q

True or false: BRAFV600E should be tested for in NSCLC and SCLC.

A

false; just NSCLC

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6
Q

Patients with EGFR mutations, ALK, or ROS-1 rearrangements typically don’t have _____ expression.

A

PD-1

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7
Q

Which has a clear relationship to smoking: SCLC or NSCLC?

A

SCLC

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8
Q

In which type of lung cancer are paraneoplastic syndromes common: SCLC or NSCLC?

A

SCLC

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9
Q

Which is more sensitive to radiation: SCLC or NSCLC?

A

SCLC

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10
Q

Which has a slower growth fraction: SCLC or NSCLC?

A

NSCLC

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11
Q

What is the ideal treatment regimen for limited-stage SCLC?

A

cisplatin + etoposide (EP) AND radiation

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12
Q

What would be an appropriate drug regimen for extensive-stage SCLC?

A

carboplatin + etoposide + atezolizumab/durvalumab

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13
Q

What drug regimen as studied in the IMpower133 Trial?

A

atezolizumab + carboplatin + etoposide

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14
Q

What drug regimen was studied in the CASPIAN Trial?

A

durvalumab + carboplatin + etoposide

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15
Q

What are some common toxicities associated with radiation therapy?

A
  • fatigue
  • esophagitis
  • pneumonitis
  • cardiac toxicity
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16
Q

Is radiation preferred in extensive-stage SCLC?

A

nope

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17
Q

What are the preferred treatment options for a SCLC relapse in 6 months or less?

A
  • topotecan PO or IV
  • lurbinectidin
  • clinical trial
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18
Q

What are the preferred treatment options for a SCLC relapse that occurs later than 6 months after treatment?

A

restart the original regimen

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19
Q

When would you consider using pembrolizumab for SCLC?

A

metastatic disease that has progressed on or after platinum-based therapy and at least 1 prior line of therapy

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20
Q

How is NSCLC staged?

A

TNM system

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21
Q

What is the standard of treatment for resectable NSCLC?

A

surgery + adjuvant chemotherapy

22
Q

What is the preferred adjuvant chemotherapy for non-squamous NSCLC?

A

cisplatin + pemetrexed

23
Q

Give a preferred adjuvant chemotherapy regimen for squamous NSCLC.

A
  • cisplatin + gemcitabine
  • cisplatin + docetaxel

(there are other recommended regimens but let’s pretend there aren’t)

24
Q

What is the standard of therapy for unresectable NSCLC?

A

chemotherapy + radiation

25
Q

Which immunotherapy would you use for unresectable, stage III NSCLC with disease that has not progressed following concurrent chemotherapy and radiation therapy (as maintenance)?

A

durvalumab

26
Q

What regimen might be used for stage IIIB/IV unresectable NSCLC?

A
  • carboplatin/paclitaxel (fewer toxicities)
  • cisplatin/paclitaxel
  • cisplatin/docetaxel
  • cisplatin/gemcitabine
27
Q

What drug may be an option for stage III unresectable NSCLC patients who aren’t candidates for surgery or definitive chemotherapy with radiation?

A

pembrolizumab

28
Q

What is the 1st line EGFR-targeting therapy for metastatic NSCLC?

A

osimertinib

29
Q

What drug can be used against T790M mutations?

A

osimertinib

30
Q

What are some common toxicities of osimertinib?

A
  • rash
  • diarrhea
  • cardiomyopathy
  • QTc prolongation
  • nail changes
31
Q

What ALK inhibitor is 1st line for metastatic NSCLC?

A

alectinib

32
Q

What toxicities are associated with alectinib?

A
  • muscle pain
  • increased LFTs
  • edema
  • electrolyte abnormalities
  • cough
  • bradycardia
  • N/V
  • constipation
  • diarrhea
33
Q

What ROS-1 therapy is 1st line for metastatic NSCLC?

A

crizotinib

34
Q

What toxicities are associated with crizotinib?

A
  • edema
  • fatigue
  • neuropathy
  • skin rash
  • N/V
  • diarrhea
  • constipation
  • increased LFTs
  • visual disturbances
  • QTc prolongation
35
Q

What BRAF therapy is 1st line against metastatic NSCLC?

A

dabrafenib + trametinib

36
Q

What toxicities are associated with dabrafenib?

A
  • fevers
  • rash
  • secondary skin cancers
  • hyperglycemia
  • visual changes
37
Q

What toxicities are associated with trametinib?

A
  • fevers
  • rash
  • hand foot syndrome
  • hypertension
  • visual changes
  • diarrhea
38
Q

What NTRK gene fusion therapy is 1st line for metastatic NSCLC?

A

larotrectinib

39
Q

What toxicities are associated with larotrectinib?

A
  • neurotoxicity
  • fatigue
  • N/V
  • constipation
  • diarrhea
  • anemia
  • increased LFTs
40
Q

What RET rearrangement therapy is 1st line for metastatic NSCLC?

A

selpercatinib

41
Q

What drug class should be avoided with selpercatinib?

A

PPIs (or give 2 hours before PPI)

42
Q

What toxicities are associated with selpercatinib?

A
  • edema
  • HTN
  • rash
  • electrolyte abnormalities
  • constipation
  • diarrhea
  • N/V
  • fatigue
  • increased LFTs
  • increased creatinine
  • thrombocytopenia
43
Q

What MET Exon 14 skipping therapy is 1st line for metastatic NSCLC?

A

capmatinib OR tepotinib

44
Q

What toxicities are associated with MET Exon 14 therapies?

A
  • edema
  • electrolyte changes
  • N/V
  • lymphocytopenia
  • increased LFTs
  • fatigue
  • increased SCr
45
Q

What KRAS G12C therapy is 1st line for metastatic NSCLC?

A

sotorasib

46
Q

What toxicities are associated with sotorasib?

A
  • N/V
  • diarrhea
  • increased LFTs
  • rash
  • edema
  • decreased hemoglobin
  • pneumonitis
47
Q

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?

A

PD-L1 (then, could use pembrolizumab)

48
Q

What oral chemotherapy is recommended for metastatic non-squamous NSCLC patients with 50%+ PD-L1?

A

cemiplimab-rwlc

49
Q

What is the preferred drug regimen for metastatic non-squamous NSCLC with no mutations?

A

carboplatin + pemetrexed + pembrolizumab

50
Q

What treatment would you recommend for metastatic squamous NSCLC (PD-L1 + PS) with no contraindication for immunotherapy?

A

pembrolizumab + carboplatin + paclitaxel/nab-paclitaxel

51
Q

What treatment would you recommend for metastatic squamous NSCLC (PD-L1 + PS) with contraindication to immunotherapy?

A

platinum doublet regardless of PD-L1 status

Fall 2021: Therapeutics III (25 decks)

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