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Oncology Exam 4
Frei Lung Cancer A
| Question | Answer |
|---|---|
| Incidence of lung cancer in males and females? | 2nd |
| Mortality of lung cancer in males and females? | 1st |
| What is the epidemiology of Lung cancer? | -Overall 5-year survival rate for all types of lung cancer is 15% -Incidence and death rate are declining faster in men than in women -Incidence increases with age; Peak age of diagnosis is between 55 and 65 *usually found and diagnosed in a metastatic setting |
| Etiology and Risk factors for development of lung cancer? | -Tobacco⭐ -Asbestos -Radon, ionizing radiation -Occupational: rock miners, coal tars, -Diet -Genetic predisposition |
| What are alternative forms of smoking? | -Vaping -E-cigarettes -Hookah -All have risk of cancer |
| E-cigarettes Health Concerns include? | -Expose users to: nicotine, carbonyl compounds, and vol-atile organic compounds (solvents, flavorants, and toxicants); Several are known carcinogens -Do usually contain fewer toxicants than combustible cigarettes Regulation is weak -Some non-nicotine products were found to have nicotine |
| Hookah Compared to Cigarettes? | -Hookah smoking has many of the same health risks as cigarette smoking: Hookah smoke is at least as toxic as cigarette smoke -Hookah smokers may absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do -An hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs |
| Relative Cancer potency modelled for common forms of nicotine delivery | -Highest lifetime cancer risk was cigarettes -Followed by heat-not-burn devices -Then e-cigarettes -Finally medicinal nicotine inhaler |
| Pathology of Lung Cancer- most common type is Adenocarcinoma includes 4 structures: | -Small-cell lung cancer (15%) (more aggressive, and different tx options. grows faster, higher mortality Non-small cell (everything else) -Large cell carcinoma (15%) -Adenocarcinoma (40%) (most common, not related to smoking) -Squamous cell carcinoma (30%) |
| Describe Small-cell lung cancer? | -Usually seen in cells near the bronchi, small-cell lung cancer is almost always caused by smoking and is very aggressive. Only 6% of US pts with small-cell lung cancer survive 5 years after diagnosis, compared with 21% of those with NSCLC |
| Describe Large cell carcinoma? | -This type of cancer can begin in any part of the lung, and often grows and spreads quickly |
| Describe adenocarcinoma? | -This is the most prevalent form of lung cancer and usually arises i the cells lining the alveoli. It is a common form of lung cancer in people who have never smoked, but is also seen in smokers |
| Describe Squamous cell carcinoma? | -These tremors appear in the flat cells that line the inside of the airways, usually near the bronchi. This form of the disease is usually caused by smoking and is more common in men than women. The tumors tend to grow slowly. |
| Prevention for lung cancer: Most important way to prevent lung cancer is _________ -test your home for radon | Not smoke; can test at home for radon as well |
| What is radon? how do you test for it? | material found in the mountains that may cause lung cancer. Use a device to measure the amount of radons since its a risk factor for getting lung cancer |
| What are the benefits of quitting smoking? | -After 20 mins, BP normalizes -After 8 hours, risk of MI start to decrease -After 1 year, reduce risk of MI in 1/2 -After 10 years, risk of lung cancer death cut in 1/2 |
| What are the screening methods for lung cancer? | -No screening methods have been proven to provide patient benefit within general population |
| What are the NCCN and USPTFS guideline recommendations for screening with annual LDCT? | -No screening methods have been proven to provide benefit within general population. -High risk group (ALL MUST BE PRESENT) (Age: 50-80; >/= 20 Pack year smoker' Active smoker or quit < 15 year *LDCT (low dose helical CT) |
| What is pack year history? Pt is a 50 yo woman who has smoked for last 30 years She smoked 2 packs a day for 15 years but then cut back on smoking to only ½ pack per day for last 15 years. -What is patient’s pack year history? -Should the patient be screened for lung cancer? | 37.5 pack year history; yes, would be screened for lung cancer |
| Clinical Presentation of Lung Cancer include? | -Cough – most common (8 – 75%) -Weight loss (0 – 68%) -Dyspnea (3 – 60%) -Chest pain (20 – 49%) -Hemoptysis (20 – 49%) |
| Clinical syndromes of lung cancer that present can include? | -Horner's syndrome -Superior vena cava syndrome -Pancoast's syndrome - shoulder pain radiating in ulnar distribution |
| Metastasis of lung cancer can occur in what sites? | Sites: bone, brain ⭐️, liver, lymph nodes, adrenal glands; *remember BRAIN |
| Pts that are classified as having small-cell lung cancer, how many (%) can have mets? | 60-70% |
| Pts that are classified as having non-small-cell lung cancer, how many (%) can have mets? | 50% |
| Pts with lung cancer can experience clinical presentations of ______ syndromes | paraneoplastic syndromes |
| Paraneoplastic syndromes includes what presentations? | -SIADH -Hypercalcemia -Anemia -Cancer-related cachexia -Acanthosis nigrans *usually more common with SCLC |
| Small cell lung cancer is the most _____ clinical course if untreated. Clear relationship with smoking and pt can present with ________ syndromes. Highly sensitive to chemotherapy and radiation | aggressive; Paraneoplastic (pancoasts, etc) |
| Small cell lung cancer staging--> Limited Stage SCLC? Extensive stage SCLC? | -Any T, Any N, M0 (except T3-4) -Any T, Any N, M1; -T3-4, Any N, Any M *"If i can treat you with one angle of radiation--> limited, if not, extensive" ⭐️ Remember that limited stage--> Curable extensive stage--> incurable |
| SCLC Staging System: 30-40% of pts with SCLC will be diagnosed under this ______ category. Description? | LIMITED; Limited to one hemithorax and regional lymph nodes can be contained in a radiation port. |
| SCLC Stagig System: 60-70% of pts with SCLC will be diagnosed under this ______ category. Description? | EXTENSIVE; Does not fit above criteria (Limited to one hemithorax and regional lymph nodes can be contained ina radiation port) |
| Stages of Small Cell lung cancer: what types of treatment can a pt classified under "Limited" category receive? | Surgery (small tumor); XRT; Chemo *Only T1-T2 and no nodal involvement qualify for surgery |
| Stages of Small Cell lung cancer: what types of treatment can a pt classified under "Extensive" category receive? | XRT; Chemo *No Surgery (not an option but still can use radiation and chemo |
| Limited Stage SCLC: prognosis? | -Survival without treatment-->11 weeks -Potentially curable -40 – 50% alive at 2 years -Median survival 18 – 24 months -Surgical resection recommended⭐ -Best results with combination chemotherapy + XRT⭐ concurrently: (4 cycles of chemotherapy) |
| For Limited Stage SCLC: Chemotherapy primary treatment consists of? | -RT + chemotherapy (Cisplatin + etoposide for 4 cycles (preferred); Alternative option: Carboplatin* + etoposide Do not use growth factors when using radiation therapy -Once chemo and radiation is complete, give consolidation therapy with durvalumab every 28 days up to 24 months or until disease recurrence **Only substitute carboplatin for cisplatin when cisplatin is contraindicated or poorly tolerated |
| Extensive Stage SCLC: Prognosis? | -Survival without treatment -->5 weeks -Rarely curable -Treatment prolongs survival up to 12 months (Treatment: combination chemotherapy alone (4 cycles of chemotherapy) -XRT can be used to palliate symptoms |
| Extensive Stage SCLC: Chemotherapy has 4 cycles: What agents can we use? | -Carboplatin (AUC 5) + etoposide 100 mg/m2 IV + checkpoint inhibitor (pick 1) Atezolizumab 1200 mg IV or Durvalumab 1500 mg IV -After 4 cycles, then continue checkpoint inhibitor single agent indefinitely *Cisplatin usually for curable and Carboplatin for Extensive stage (incurable) just aiming for QoL and prolong life |
| Overall survival with Atezolizumab Addition to Chemo for Extensive Stage SCLC: | Overall survival was extended when you had the addition of Atezolizumab and that also happened with the Durvalumab. |
| Progression Free Survival with Atezolizumab Addition to Chemotherapy for Extensive Stage SCLC: | 1 month difference (statistically significant of how long it took for progression to occur |
| What cancer drug dose is calculated based on AUC? | Carboplatin⭐️; Formula used Calvert Formula: AUC x (CrCl + 25) |
| For pts with Recurrent SCLC--> Treatment pathways are: - </= 6 months? >6 months? | </= 6 months (Pick 1): Topotecan; Lurbinectedin; Irinotecan; Tarlatamab-dlle > 6 months: Original regimen |
| Radiation for SCLC: | -Prophylactic craial raditation; Thoracic radiation (extensive stage); Cranial radiation Tx if brain mets present |
| Radiation for SCLC: Pts can get thoracic radiation during extensive stages, what about for limited and extensive SCLC for prophylactic cranial radiation? | Limited SCLC: Dec brain mets, Improves disease free survival, Improves overall survival, Given after adjuvant chemotherapy (give brain radiation) Extensive SCLC (if no mets preset): Decreases brain mets, no effect on survival -Thoracic radiation - extensive stage -Cranial Radiation tx if brain mets present |
| Non-Small cell lung cancer: is generally ____ growing; moderately sensitive to radiation; low sensitivity to radiation. ________ most common type in non-smokers. _______ cell clearly related to smoking, dose-related effects | slower; Adenocarcinoma; Squamous |
| Stage of NSCLC: Treatment for Stage 1A? | Surgery only *know that surgery is the main stay in curable non-small cell lung cancer |
| Stage of NSCLC: Treatment for Stage IB, IIA, IIB? | Surgery and Chemo |
| Stage of NSCLC: Treatment for Stage IIIA? | Surgery, XRT, Chemo |
| Stage of NSCLC: Treatment for Stage IIIB? (incurable) | XRT and Chemo |
| Stage of NSCLC: Treatment for Stage IV? (Incurable), metastatic | Chemo only |
| Treatment for Resectable Lung Cancer? | -Test for PD-L1 status, EGFR mutations, and ALK rearrangements -Includes Stage I, II: Resection of tumor --> Observe or Adjuvant (meaning after surgery) chemotherapy -Includes Stage some II and III: Neoadjuvant (before surgery) --> Resection |
| Neoadjuvant Treatment for Resectable NSCLC (II-IIIA) includes the selection of? | 1 checkpoint inhibitor + 1 platinum-doublet chemotherapy * If not eligible for checkpoint inhibitor, give chemotherapy only |
| Neoadjuvant Treatment for Resectable NSCLC (II-IIIA), what are the Checkpoint inhibitors? | Nivolumab, Perbrolizumb, Durvalumab * If not eligible for checkpoint inhibitor, give chemotherapy only |
| Neoadjuvant Treatment for Resectable NSCLC (II-IIIA), what are your platinum-doublet chemotherapy? | -Cisplatin + gemcitabine (Squamous histology) -Cisplatin + Paclitaxel (any histology) -Cisplatin _ Pemetrexed (nonsquamos histology) * If not eligible for checkpoint inhibitor, give chemotherapy only |
| Adjuvant Treatment for Resectable NSCLC (II-IIIA): For pts that have no prior therapy, pt should receive what treatments? | Cis + Pemetrexed (nonsquamous) OR Cis + gemcitabine (squamous) OR Cis + Docetaxel (Squamous) Then choose 1 of the below: -ALK rearrangement (Alectinib 600 mg PO BID x 2 years -EGFR exon 19 deletion or exon 21 L858R mutation (Osimertinib 80 mg PO daily x 3 years -PDL>/= 1% w/o EGFR and ALK biomarkers (Atezolizumab for 1 year) -W/o EGFR and ALK biomarkers (Pembrolizumab) -If durvalumab or Nivolumab in neoadju. and w/o EGFR and ALK biomarkers--> Duvalumab for 12 cycles OR Nivolumab for 13 cycles) |
| Unresectable Lung Cancer Stage III: Chemoradiation (Pick 1) Then Consolidation therapy(Pick 1): What are the chemoradiation options? | -Cisplatin or Carboplatin + Pemetrexed (nonsquamous only) -Paclitaxel + carboplatin (any histology) -Cisplatin + etoposide (any histology) *unresectable, cant cut it out |
| Unresectable Lung Cancer Stage III: Chemoradiation (Pick 1) Then Consolidation therapy(Pick 1): What are the consolidation therapy options? | -Osimertinib 80 mg PO daily until disease progression (for EGFR deletion) -Durvalumab 10 mg/kg IV every 2 weeks for up to 12 months (based on PACIFIC trial) *unresectable, cant cut it out |
| Poll: Which of the following is true about lung cancer? | Non-small cell lung cancer is more common that small-cell lung cancer |
| Poll: First line tx for extensive stage small cell lung cancer is? | Atezolizumab + carboplatin + etoposide *dose limiting of carboplatin--> Myelosuppression *Dose limiting of cisplatin--> N/V and Nephrotoxicity |
| Poll: which of the following is highest risk of lung cancer? | 56 yo male with a 40yr history of cigarette smoking |
| Poll: 55 yo SCLC with extensive stage. (Performance Status) PFS 1. What is best treatment? | Atezolizumab + carboplatin + etoposide x 4 cycles then atezolizumab until disease progression |
Created by:
Xander635
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