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Oncology Exam 4
Frei Lung Cancer Metastatic B
| Question | Answer |
|---|---|
| Metastatic NSCLC: Treatment Decisions DEPEND on performance status: Grades 0, 1, 2, 3, 4, 5? | 0 and 1 are considered good. 2? chemo? grey. |
| Advanced or Metastatic NSCLC Unfit pt would have a performance status of __-__ and have ___ benefit from cytotoxic treatment | 3-4; NO |
| NSCLC Stage IV Unfit pt with ALK rearrangement. What is the 1st line option? | Alectinib or Brigantinib or Lorlatinib or Ensartinib |
| NSCLC Stage IV Unfit pt with ROS1 rearrangement. What is the 1st line option? | Entrectinib or Crizotinib or Repotrectinib |
| NSCLC Stage IV Unfit pt with EGFR mutation. What is the 1st line option? | Osimertinib or Afatinib |
| NSCLC Stage IV Unfit pt with BRAF V600E. What is the 1st line option? | Dabrafenib + Trametinib OR Encorafenib + blinimetinib |
| NSCLC Stage IV Unfit pt with NTRK gene fusion. What is the 1st line option? | Entrectinib or Larotectinib or Repotrectinib |
| NSCLC Stage IV Unfit pt with MET ex 14 skipping mutation. What is the 1st line option? | Capmatinib or Tepotinib |
| NSCLC Stage IV Unfit pt with . What is the RET rearrangement1st line option? | Selpercatinib or Pralsetinib |
| NSCLC Stage IV Unfit pt with PDL1 expression >/= 50%. What is the 1st line option? | Pembrolizumab or Atezolizumab or Cempilimab-rwlc |
| NSCLC Stage IV Unfit pt with NO mutations. What is the 1st line option? | supportive care |
| Advanced or Metastatic NSCLC FIT pt: looking at histology of ______ is important. Suvival is strongly correlated with: | NSCLC; -Stage, Weight loss, Performance status, Female Gender |
| NSCLC Stage IV FIT pt with ALK rearrangement. What is the 1st line option? | Alectinib or Brigatinib or Lorlatinib, or Ensartinib |
| NSCLC Stage IV FIT pt with ROS1 rearrangement. What is the 1st line option? | Entrectinib or Crizotinib or Repotrectinib |
| NSCLC Stage IV FIT pt with EGFR mutation. What is the 1st line option? | Osimertinib or Afatinib or Amivantamab-vxjw + Carboplatin + pemetrexed (non-squamous) |
| NSCLC Stage IV FIT pt with BRAF V600E. What is the 1st line option? | Dabrafenib + trametinib or Encorafenib + Binimetinib |
| NSCLC Stage IV FIT pt with NTRK gene fusion. What is the 1st line option? | Entrectinib or Larotrectinib or Repotrectinib |
| NSCLC Stage IV FIT pt with MET ex14 skipping mutation. What is the 1st line option? | Capmatinib or Tepotinib |
| NSCLC Stage IV FIT pt with RET rearrangement. What is the 1st line option? | Selpercatinib or Pralsetinib |
| NSCLC Stage IV FIT pt with PDL1 expression >/= 50%. What is the 1st line option? | Pembrolizumab or Atezolizumab or Cemiplimab-rwlc |
| NSCLC Stage IV FIT pt with NO mutations. What is the 1st line option? | 1st line chemotherapy/ Checkpoint inhibitor |
| What are the ADRs of Targeted 1st line therapies: Checkpoint inhibitors? | Immune related AE: Rash, Colitis, Hepatitis, Endocrinopathies, Nephritis *(given IV) |
| What are the ADRs of Targeted 1st line therapies: Osimertinib? | Diarrhea, Rash or Acne, Stomatitis, Paranychia (cuticles of hands and feet get sensitive) *given PO |
| What are the CIs to Checkpoint Inhibitors? | -Active or previously documented autoimmune disease and/or current use of immunosuppressive agents or presence of an oncogene |
| Advanced or Metastatic NSCLC FIT patient: Tx considerations for Stage IV? | -Inc survival for chemo vs best supportive care -Platinum based chemotherapy best choice -No platinum has been shown to be superior |
| Advanced or Metastatic NSCLC FIT patient: General response rates in FIT pts receiving chemotherapy: | -Overall response rates (~25 – 35%) -Time to progression ( 4 – 6 mo) -Median survival (8 – 10 mo) -1-year survival rate (30 – 40%) -2-year survival rate (10 – 15%) |
| Advanced/Metastatic NSCLC: First-line therapy in FIT patients no mutations: Pts that are NSCLC, NON-SQUAMOUS: tx option? | (Carb or cis) + pemetrexed + pembrolizumab* or (Carb or cis) + pemetrexed + cemiplimab* *PDL1 expression is not relevant |
| Advanced/Metastatic NSCLC: First-line therapy in FIT patients no mutations: Pts that are NSCLC, SQUAMOUS: tx option? | Carbo + (paclitaxel or albumin bound paclitaxel) + pembrolizumab* or (Carbo or Cis) + paclitaxel or cemiplimab-rwlc *PDL1 expression is not relevant |
| Pts that are NSCLC stage IV with no mutations and tried 1st line: If pts had progression? | Go to 2nd line |
| Pts that are NSCLC stage IV with no mutations and tried 1st line: If pts had a response? | Go to maintenance (Switch or continue)--> Recurrence--> 2nd line |
| Advanced or Metastatic NSCLC: Maintenance Therapy in FIT patients: So continuing maintenance? | use at least one agent given in first line; or Switch maintenance (use a different agent, not included in 1st line regimen) but ensure no progression has occured, otherwise, 2nd line |
| Pharmacist's role includes? | -Managing the chemotherapy toxicities -Supportive Care -Checking for drug interactions between medications, chemotherapy, OTCs, vitamins, and herbals |
| Minimize risk in cancer treatment by monitoring and using caution with meds that may cause these ADRs: | -Myelosuppression -N/V -Nephrotoxicity -Peripheral Neuropathy |
| Chemotherapy vs Immunotherapy Toxicities and effects: Chemotherapy toxicities include? | -Myelosuppression, N/V, Alopecia, Fatigue, Neuropathy |
| Chemotherapy vs Immunotherapy Toxicities and effects: Immune-related Adverse Effects (irAEs) include? | -Skin rash, pruritis, Endocrinopathies, liver toxicity, Diarrhea colitis, Pneumonitis, Nephritis *Unlike chemotherapy, immunotherapy does not have dose reductions to manage toxicities |
| Routine monitoring of immunotherapy: General? | CBC and Chem 20 at baseline and at each tx or at least monthly; Infectious disease screening; Baseline bowel assessment (Frequency); Physical exam; Neurological exam; Endocrine: TSH and free T4 baseline and every 6-8 wks; Skin: Examine skin and mucosa initially and as needed Pulmonary: O2 saturation at baseline Optional: ECG, Cortisol level, PFTs |
| Estimated Frequency of irAEs: | Skin, GI, Endocrine, Hepatic, Pulmonary, Renal *Highest to lowest |
| Timing for irAEs? | Skin and colitis occur the most. |
| ADRs for carboplatin include? | Myelosuppression ⭐, N⭐, V⭐, Nephrotoxicity, peripheral neuropathy, Metallic taste |
| ADRs of Paclitaxel? | Full body alopecia ⭐, Peripheral Neuropathy ⭐, Myelosuppression ⭐, N/V, Allergic rxn, Extravasation (vesicant/irritant |
| ADRs of Pemetrexed? | Myelosuppression, D/C, rash, N/V (low), renal dysfunction (5%); *Give folic acid 400 to 1000 mcg orally daily (7 days prior to treatment and continuing for 21 days after the last pemetrexed dose); and vitamin B12, 1 mg IM (beginning 1 week prior to pemetrexed and then every 3 cycles thereafter) |
| CDK 4/6 Inhibitor for Primary Prevention of Febrile Neutropenia: Trlaciclib? | -Non-small cell lung cancer prior to platinum/etoposide +/- immune checkpoint inhibitor -Extensive stage small cell lung cancer prior to topotecan-containing regimen -MGFs can be given starting with cycle 2 |
| Lung Cancer Conclusion: | -Lung cancer is the second leading cause of cancer in both genders and has caused the most deaths of any cancer -Tobacco smoking is the leading cause of lung cancer and the most modifiable -There are no recommended screening guidelines |
| Dose limiting of Cisplatin | Nephrotoxicity |
| Dose limiting of Oxaliplatin? | Peripheral Neuropathy (Immediate, cold-induced) |
| Poll: 68 yo female with a good Performance status diagnosed with metastatic NSCLC, non-squamous. Analysis of tumor shows a 60% PDL1 expression. What is best first line treatment for her? | Pembrolizumab |
Created by:
Xander635
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