VP L3 Lung cancer Flashcards
Mortality rate of lung cancer
80% die within one year of diagnosis
Smoking is associated with …..% of LC cases
90
Risk factors other than being a smoker (5)
passive smoking asbestos radon gas previous lung disease family history
2 types of lung cancer
Which is most common?
Small cell lung cancer (20%)
Non small cell lung cancer (80%)
Describe the cells in SCLC v NSCLC
small and uniform
vs
several types (squamous cell, adenocarcinoma, large cell)
What is the role of surgery/chemo/radio in SCLC v NSCLC
SCLC - surgery has a limited role. Responds well to chemo and radio therapy.
NSCLC - sugery more often used, limited response to chemo
What is the role of surgery/chemo/radio in SCLC v NSCLC
SCLC - surgery has a limited role. Responds well to chemo and radio therapy.
NSCLC - sugery more often used, limited response to chemo
Clinical presentation of lung cancer
Persistent cough SOB/weezing Haemoptysis Chest, shoulder or back pain Weight loss Fatigue
Often diagnosed by
X-ray
>50% of patients metastatic at presentation
often initially confused with COPD
Diagnostic tests
Chest Xray
Broncoscopy and biopsy
Sputum cytology
CT scan (to assess suitability for surgery/find metstasis)
Lung function tests to establish baseline
Stages of lung cancer outline (2)
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
Dont bother learning stages but
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
Treatment options for LC
Surgery Radio therapy Chemo Novel therapies Best supportive care
SCLC often has a good/poor responce to chemo
Good initial response then
SCLC often has a good/poor responce to chemo
Good initial response then relapse.
SCLC - if a patient is at least 6 months stable disease what do you treat them with in relapse?
The same agent
(If
What is usually 1st line regimen for SCLC
(drugs and cycle length and no of cycles(
Carboplatin + etoposide
21 days for 4 cycles
What is usually 2nd line regimen for SCLC
CAV
cyclophosphamide, doxorubicin, vincristine
Is SCLC senstive to radio therapy?
What is the problem?
When is it given?
Yes sensitive but the dose is limited as the thorax contains many sensitive vital organs
In combo with chemo in limited stage OR plalliatively
Why use radiotherapy palliatively? (SCLC)
To control symptoms such as bone pain, & large airway narrowing
When is surgery used?
NSCLC stages I and II (maybe IIIa if shrunk by chemo first)
Types of surgery (2)
Lobectomy
Pneumonectomy - removal of the whole lung, often has complications.
What complicates chemo in NSCLC
pt often have co morbidities
Stages I & II NSCLC what chemo is used
Stages III & IV?
I & II - cisplatin based regimen
(use as adjutant to surgery/chemo)
III & IV - combo cisplatin and permetrexed
Why use chemo with surgery (2)
Less extensive surgery may be needed
Eradicates micro-metastases at start of treatment
Why use chemo with surgery (2)
Less extensive surgery may be needed
Eradicates micro-metastases at start of treatment
Cisplatin and vinorelbine s/e
nausea & vomiting bone marrow suppression mucositis constipation alopecia peripheral neuropathy nephrotoxicity & ototoxicity
Cisplatin and vinorelbine - why must people have inpatient stay for this
hydration
Cisplatin and vinorelbine cycle length and bonus details
Cisplatin 80mg/m2 IV infusion day 1
Vinorelbine 30mg/m2 IV stat day 1 & 8
Given every 21 days for max. 4 courses
Cisplatin and vinorelbine cycle length and bonus details
Cisplatin 80mg/m2 IV infusion day 1
Vinorelbine 30mg/m2 IV stat day 1 & 8
Given every 21 days for max. 4 courses
Things to check before Cisplatin and vinorelbine regimen
FBC, body surface area and dose.
Renal function - GFR must be >55ml/min
recalculate before each cycle
What 2 things should be prescibed with the Cisplatin and vinorelbine regieme?
- Antiemetics
2. pre and post hydration with cisplatin (3L before and after) - ensure urine output of 6-8 hours after cisplatin admin)
What 2 things should be prescibed with the Cisplatin and vinorelbine regieme?
- Antiemetics
2. pre and post hydration with cisplatin (3L before and after) - ensure urine output of 6-8 hours after cisplatin admin)
When might a patietn need addtional diuressis with Cisplatin and vinorelbine
inadequate urine output or wight gain (fluid retention)
What should we monitor patients for during Cisplatin and vinorelbine regiemen
Cisplatin-induced wasting of electrolytes - Mg, Ca & K.
Supplements may be needed
What sort of molecule is vinorelbine
Vinorelbine – vinca alkaloid, must be diluted to 50mls with NaCl 0.9%
What sort of molecule is gefitinib?
What does it target?
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.
How is gefitanib administered
Oral agent – 250mg daily
When is gefitanib recommended?
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.
What mutation must be carried to have Gefitanib?
Only for patients with EGFR-TK mutation – worse outcome if gefitinib is given to EGFR-TK negative patients
Erlotinib is a novel therapy targeting
Erlotinib targets & inhibits the tyrosine kinase region of EGF receptor
Erlotinib is licensed 1st line for ….
or second line for…..
Licensed for 1st line treatment of locally advanced or metastatic NSCLC or 2nd line after failure of previous chemotherapy
How is erlotinib administered
orally 150mg daily
Limitations of evidence behind erlotinib
No trials comparing this erlotinib and docetaxel (another option 2nd line)
Erlotinib is also called
Tarceva
s/e erlotinib
acne-like rash (75%)
diarrhoea (55%)
What is treatment of choice for early stage (stage I-III) NSCLC pts who are not suitable for surgery –
Radiotherapy - given with curative intent daily over 3-4 weeks
When do we use radical (high dose) radio therapy
Only small % of pts are suitable for this as tumour must be
