Treatment of Lung Cancer Flashcards
In general terms, how do you treat stage 1-2 NSCLC?
Surgical resection
What is the category for NSCLC to merit further treatment, other than resection? What is the treatment?
Stage 3-4
Resected surgically but surrounding lymph nodes are +
> 4cm width
Treat with Adjuvant 2-agent chemo consisting of one platinum-based agent + another chemo drug.
MUST HAVE A PLATINUM BASED AGENT
How do you treat metastatic SCLC?
Radiation is the only option.
How do you treat both SCLC and NSCLC if they are confined to the chest and mediastinal lymph nodes?
Combined chemo/radiation
Tx for adenocarcinoma with an EGFR mutation.
Erlotinib
Tx for adenocarcinoma with an ALK translocation.
Crizotinib
How do you treat inoperable adenocarcinoma?
Double agent chemotherapy with 1. Cisplatin or Carboplatin \+ one of the following: a. Paclitaxel b. Etoposide c. Pemetrexed
+/- Bevacizumab
For Adenocarcinoma, when is Bevacizumab shown to be helpful?
Only when combined with Carboplatin and Paclitaxel.
MOA of Paclitaxel,
Paclitaxel and Docitaxel are TAXANES! Mitotic spindle inhibitors. Prevent microtubules from de-polymerizing. THey stabilize the microtubule structure.
Worst toxicity of Taxanes. (Also with Vinca alkaloids)
Peripheral Neuropathy - tingling of the extremities.
Pemetrexed works by what MOA?
It’s a thymidylate synthase inhibitor. Prevents purine and pyrimidine synthesis, therefore blocks the synthesis of DNA/RNA.
Etoposide works by what mechanism?
Etoposide/Toniposide are Topoisomerase inhibitors. Prevent repair after strand breakage.
How does Bevacizumab work?
It’s a VEGF inhibitor, preventing the proliferation of vascular epithelium. Starves the tumor of its nutrient supply.
In which cancer is Bevacizumab contraindicated?
Squamous cell carcinoma! It causes hemorrhages, some fatal.
What is the treatment for an unoperable case of squamous cell carcinoma? (2 drug regimen)
Cisplatin/Carboplatin +
a. Paclitaxel
b. Etoposide
c. Vinorelbine
