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LUNG CANCER
| Question | Answer | |||
|---|---|---|---|---|
| LUNG CANCER STATS | #2 most common cancer in men and women #1 cancer in mortality | |||
| Lung cancer RF | Tobacoo, asbestos, Radon, ionizing radiation, occupation of rock mining or coal tars, diet, genetic predisposition | |||
| Highest to lowest cancer risk per smoking modality | 1. cigarettes 2. heat non- burn devices 3. e-cigarrettes 4. Nicotine inhalers | |||
| Most common type of LC | ADENOCARINOMA followed by squamous cell carcinoma, then large cell carinoma and small cell lung cancer | |||
| Prevention of lung cancer | SMOKING CESSATION - test home for radon | |||
| Benefits of quitting smoking | - normal BP after 20 min - MI risk decreases after 8 hours - MI risk reduces in half after a year - Lung cancer risk cut in half after 10 years | |||
| Screening for LC | - GENERAL POP: no screening proven to provide benefit - HIGH RISK GROUP (all must be present) * Age 50-80, ≥20 pack year smoker, Active smoker or quit <15 years ago Screen patients with LOW DOSE HELICAL CT | |||
| Clinical Presentation of Lung Cancer | s/sx: cough (most common), weight loss, dyspnea, chest pain, hemoptysis | syndromes: horners, superior vena cava, pancoasts Metastases: sites are bone, BRAIN, liver, LN, adrenal glands. SCLC 60-70% with mets and NSCLC 50% present with mets | Paraneoplastic syndromes: SIADH, hypercalcemia, anemia, cancer related cachexia, acanthosis nigrans MORE COMMON W/ SCLC | |
| Small cell lung cancer (SCLC) | Most aggressive clinical course if untreated, tied to smoking, paraneoplastic syndromes, highly sensitive to chemo and radiation | |||
| SCLC Staging | Limited stage: - LIMITED TO ONE HEMITHORAX AND REGIONAL LN ARE CONTAINED WITH XRT ANY T, N, M0 EXCEPT bulky T3-T4 that cannot be safely radiated (contained to the chest) | Extensive Stage SCLC: Any M1, N, T, T-3-T4 (distant metastasis) or bulky/unresectable T3-T4, disease spread beyond chest | ||
| LIMITED SCLC Treatment types | limited: Surgery ONLY for T1-T2 tumors and no nodal involvement, XRT and chemo! | Limited: XRT + CHEMO - Cisplatin + etoposide for 4 cycles (preferred) ALT: Carboplatin + etoposide...only sub for carbo if Cis is CI or poorly tolerated | NO GROWTH FACTORS WHILE ON XRT give consolidation therapy with durvalumab Q 28 days up to 24 mos or until disease recurrence | |
| EXTENSIVE SCLC | EXTENSIVE: chemo + XRT | EXTENSIVE CHEMO: - Carboplatin (AUC 5) + etoposide + a check point inhibitor (PICK 1) - atezolizumab - durvalumab | After 4 cycles of chemo continue check point inhibitors indefinitely | you can replace ATEZO with lurbinectedin if pt relapses but ONLY if on Atezolizumab previously |
| CALVERT FORMULA | AUC * (CrCl + 25) = Dose (mg) | used to calculate dose of carboplatin based on AUC/ renal fx | ||
| TXT for Recurrent SCLC | ≤6 mos: Tarlatamab-dlle >6 mos: original regimen w or w/o immunotherapy | |||
| Stage of NSCLC + Treatment | Stage IA: surgery only Stage IB - IIB: surgery + chemo Stage IIIA: Surgery + XRT + Chemo Stage IIIB: XRT + Chemo Stage IV: Chemo only | |||
| NEOADJUVANT Treatment for RESECTABLE NSCLC (II-IIA) | checkpoint inhibitor + Platinum-doublet chemo ***If pt is not eligible for check point inhibitor then chemo only | check point inhibitors = Nivolumab, Pembrolizumab, Durvalumab | Platinum-doublet chemos: - cisplatin + gemcitabine (use if squamous histology) - Cistplatin + paclitaxel (any histology) - Cisplatin + pemetrexed (nonsquamous histology) | |
| ADJUVANT treatment for resectable NSCLC (II-IIIA) | if not prior treatment give: cisplatin + gemcitabine (squamous) - Cistplatin + docetaxel (squaomous) - Cisplatin + pemetrexed (nonsquamous histology) THEN CHOOSE 1: Alectnib, Osimertinib, Atezolizumab, Pembrolizumab | |||
| UNRESECTABLE Lung Cancer Stage III | 1st: Chemoradiation (pick 1): * Cisplatin + Pemetrexed (nonsquamous) * Paclitaxel + Carboplatin (any histology) * Cisplatin + Etoposide (any hist) | 2nd: Consolidation (pick 1): *Osimertinib until disease progression or EGFR deletion * Durvalumab every 2 weeks up to 12 mos | ||
| NSCLC Stage IV UNFIT Pt (ALK REARRANGEMENT) | Alectinib, Brigatinib, Lorlatinib or Ensartinib | |||
| NSCLC Stage IV UNFIT Pt (ROS1) | Entrectinib or Crizotinib or Repotrectinib | |||
| NSCLC Stage IV UNFIT Pt (EGFR MUTATION) | Osimertnib or Afatinib | |||
| NSCLC Stage IV UNFIT Pt (BRAF V600E) | Dabrafenib + Trametinib or Encorafenib + Binimetinib | |||
| NSCLC Stage IV UNFIT Pt (NTRK GENE FUSION) | Entrectinib or Larotrectinib or Bepotrectinib | |||
| NSCLC Stage IV UNFIT Pt (MET ex14 skipping mutation) | Capmatinib or Tepotinib | |||
| NSCLC Stage IV UNFIT Pt (RET rearrangement) | Selpercatinib or Pralsetinib | |||
| NSCLC Stage IV UNFIT Pt (PDL1 expression ≥50%) | Pembrolizumab or Atezolizumab or Cemiplimab-rwlc |
Created by:
texantaco