VP L3 Lung cancer

Question 1

Mortality rate of lung cancer

Answer 1

80% die within one year of diagnosis

Question 2

Smoking is associated with …..% of LC cases

Answer 2

90

Question 3

Risk factors other than being a smoker (5)

Answer 3

passive smoking
asbestos 
radon gas
previous lung disease
family history

Question 4

2 types of lung cancer

Which is most common?

Answer 4

Small cell lung cancer (20%)

Non small cell lung cancer (80%)

Question 5

Describe the cells in SCLC v NSCLC

Answer 5

small and uniform

vs

several types (squamous cell, adenocarcinoma, large cell)

Question 6

What is the role of surgery/chemo/radio in SCLC v NSCLC

Answer 6

SCLC - surgery has a limited role. Responds well to chemo and radio therapy.

NSCLC - sugery more often used, limited response to chemo

Question 7

What is the role of surgery/chemo/radio in SCLC v NSCLC

Answer 7

SCLC - surgery has a limited role. Responds well to chemo and radio therapy.

NSCLC - sugery more often used, limited response to chemo

Question 8

Clinical presentation of lung cancer

Answer 8

Persistent cough
SOB/weezing
Haemoptysis
Chest, shoulder or back pain
Weight loss
Fatigue

Question 9

Often diagnosed by

Answer 9

X-ray
>50% of patients metastatic at presentation

often initially confused with COPD

Question 10

Diagnostic tests

Answer 10

Chest Xray
Broncoscopy and biopsy
Sputum cytology
CT scan (to assess suitability for surgery/find metstasis)
Lung function tests to establish baseline

Question 11

Stages of lung cancer outline (2)

Answer 11

Limited stage disease – cancer is confined to one side of the chest & involved lymph nodes can be treated with radiotherapy
Extensive stage disease – cancer has metastasised to distant organs

Question 12

Dont bother learning stages but

Answer 12

Stage I & II – primary tumour in 1 lung lobe with
lymph node involvement confined to hilar nodes
Stage IIIa – locally advanced with involvement of
mediastinal lymph nodes
Stage IIIb – locally advanced with pleural
effusion & involvement of contralateral media-
stinal lymph nodes
Stage IV – metastases to other organs

Question 13

Treatment options for LC

Answer 13

Surgery
Radio therapy
Chemo
Novel therapies
Best supportive care

Question 14

SCLC often has a good/poor responce to chemo

Answer 14

Good initial response then

Question 15

SCLC often has a good/poor responce to chemo

Answer 15

Good initial response then relapse.

Question 16

SCLC - if a patient is at least 6 months stable disease what do you treat them with in relapse?

Answer 16

The same agent

(If

Question 17

What is usually 1st line regimen for SCLC

(drugs and cycle length and no of cycles(

Answer 17

Carboplatin + etoposide

21 days for 4 cycles

Question 18

What is usually 2nd line regimen for SCLC

Answer 18

CAV

cyclophosphamide, doxorubicin, vincristine

Question 19

Is SCLC senstive to radio therapy?

What is the problem?

When is it given?

Answer 19

Yes sensitive but the dose is limited as the thorax contains many sensitive vital organs

In combo with chemo in limited stage OR plalliatively

Question 20

Why use radiotherapy palliatively? (SCLC)

Answer 20

To control symptoms such as bone pain, & large airway narrowing

Question 21

When is surgery used?

Answer 21

NSCLC stages I and II (maybe IIIa if shrunk by chemo first)

Question 22

Types of surgery (2)

Answer 22

Lobectomy

Pneumonectomy - removal of the whole lung, often has complications.

Question 23

What complicates chemo in NSCLC

Answer 23

pt often have co morbidities

Question 24

Stages I & II NSCLC what chemo is used

Stages III & IV?

Answer 24

I & II - cisplatin based regimen
(use as adjutant to surgery/chemo)

III & IV - combo cisplatin and permetrexed

Question 25

Why use chemo with surgery (2)

Answer 25

Less extensive surgery may be needed | Eradicates micro-metastases at start of treatment

Question 26

Why use chemo with surgery (2)

Answer 26

Less extensive surgery may be needed | Eradicates micro-metastases at start of treatment

Question 27

Cisplatin and vinorelbine s/e

Answer 27

``` nausea & vomiting bone marrow suppression mucositis constipation alopecia peripheral neuropathy nephrotoxicity & ototoxicity ```

Question 28

Cisplatin and vinorelbine - why must people have inpatient stay for this

Answer 28

hydration

Question 29

Cisplatin and vinorelbine cycle length and bonus details

Answer 29

Cisplatin 80mg/m2 IV infusion day 1 Vinorelbine 30mg/m2 IV stat day 1 & 8 Given every 21 days for max. 4 courses

Question 30

Cisplatin and vinorelbine cycle length and bonus details

Answer 30

Cisplatin 80mg/m2 IV infusion day 1 Vinorelbine 30mg/m2 IV stat day 1 & 8 Given every 21 days for max. 4 courses

Question 31

Things to check before Cisplatin and vinorelbine regimen

Answer 31

FBC, body surface area and dose. Renal function - GFR must be >55ml/min recalculate before each cycle

Question 32

What 2 things should be prescibed with the Cisplatin and vinorelbine regieme?

Answer 32

1. Antiemetics | 2. pre and post hydration with cisplatin (3L before and after) - ensure urine output of 6-8 hours after cisplatin admin)

Question 33

What 2 things should be prescibed with the Cisplatin and vinorelbine regieme?

Answer 33

1. Antiemetics | 2. pre and post hydration with cisplatin (3L before and after) - ensure urine output of 6-8 hours after cisplatin admin)

Question 34

When might a patietn need addtional diuressis with Cisplatin and vinorelbine

Answer 34

inadequate urine output or wight gain (fluid retention)

Question 35

What should we monitor patients for during Cisplatin and vinorelbine regiemen

Answer 35

Cisplatin-induced wasting of electrolytes - Mg, Ca & K. | Supplements may be needed

Question 36

What sort of molecule is vinorelbine

Answer 36

Vinorelbine – vinca alkaloid, must be diluted to 50mls with NaCl 0.9%

Question 37

What sort of molecule is gefitinib? What does it target?

Answer 37

Gefitinib is a selective inhibitor of epidermal growth factor receptor tyrosine kinase (EGFR-TK) which blocks the signal pathways involved in cell proliferation. By blocking EGFR-TK, gefitinib helps to slow the growth and spread of the cancer.

Question 38

How is gefitanib administered

Answer 38

Oral agent – 250mg daily

Question 39

When is gefitanib recommended?

Answer 39

option for the first-line treatment of people with locally advanced or metastatic (stage III or IV) non-small-cell lung cancer (NSCLC) if: • they test positive for the epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation and • the manufacturer provides gefitinib at the fixed price agreed under the patient access scheme.

Question 40

What mutation must be carried to have Gefitanib?

Answer 40

Only for patients with EGFR-TK mutation – worse outcome if gefitinib is given to EGFR-TK negative patients

Question 41

Erlotinib is a novel therapy targeting

Answer 41

Erlotinib targets & inhibits the tyrosine kinase region of EGF receptor

Question 42

Erlotinib is licensed 1st line for .... or second line for.....

Answer 42

Licensed for 1st line treatment of locally advanced or metastatic NSCLC or 2nd line after failure of previous chemotherapy

Question 43

How is erlotinib administered

Answer 43

orally 150mg daily

Question 44

Limitations of evidence behind erlotinib

Answer 44

No trials comparing this erlotinib and docetaxel (another option 2nd line)

Question 45

Erlotinib is also called

Answer 45

Tarceva

Question 46

s/e erlotinib

Answer 46

acne-like rash (75%) | diarrhoea (55%)

Question 47

What is treatment of choice for early stage (stage I-III) NSCLC pts who are not suitable for surgery –

Answer 47

Radiotherapy - given with curative intent daily over 3-4 weeks

Question 48

When do we use radical (high dose) radio therapy

Answer 48

Only small % of pts are suitable for this as tumour must be