Term
| What are the 2 primary types of lung cancer? |
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Definition
- Non small cell - Adenocarcinoma (40%) or Squamous cell carcinoma (30%), large cell (15%)
- Small cell - 15% |
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Term
| What are risk factors that can lead to lung cancer? |
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Definition
- Active smoking - 90%. Risk declines after cessation
- Occupation - Asbestos
- Mutation - p53 and KRAS |
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Term
| What screening can be used for lung cancer? |
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Definition
- Chest Xray - incr finding, earlier staging
- Low dose spiral CT - not recommended
**Screening not recommended at all |
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Term
| How is lung cancer diagnosed? |
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Definition
- CHEST XRAY, CT scan
- CBC counts
- NSCLC - MRI + PET + bone scan
- SCLC - CT of chest, liver, adrenal, brain, bone |
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Term
| What are signs/symptoms indicating presence of lung cancer? |
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Definition
- Cough - most common
- Weight loss
- Chest pain
- Hemoptysis
- Hoarseness
- Bone pain
- Dysphagia
- Fatigue |
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Term
| What are common site of metastasis for lung cancer? |
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Definition
- Lymph nodes
- brain
- Bone
- Liver
- Adrenal gland |
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Term
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Definition
- Slower growing, less sensitive to chemo. 50% have metastasis
- Adenocarcinoma - most common in nonsmokers, women
- Squamous carcinoma - CLEAR relation to smoking
- Large cell - hard to treat |
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Term
| What are the 3 groups of NSCLC? |
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Definition
- Resectable disease (stage 1, 2, some 3)
- Local/regionally advanced disease
- Distant metastatic - no single therapy |
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Term
| What is the tx of choice for resectable NSCLC? |
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Definition
Stages I, II, and IIIA;
- Surgery - Tx of choice
- Radiation - curative intent in inoperable patients
- Chemo - CISPLATIN based the standard in stages 2 and 3
**Do NOT use alkylating agents |
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Term
| How is resectable stage 3a NSCLC managed? |
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Definition
- Cisplatin therapy for induction + Radiation - Cisplatin/Etoposide or Cisplatin/Vinblastine preferred. Pemetrexed for nonsquamous
- Surgery may or may not be used |
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Term
| How is radiation used for NSCLC? |
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Definition
- Adjuvant in resectable lung cancer
- PRIMARY in unresectable
- Palliative for incurable disease
- Prophylactic cranial XRT does not improve survival in patients with NSCLC |
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Term
| How is stage 4 NSCLC treated? |
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Definition
- Platinum based chemo prolongs survival
- Erlotinib for EGFR+ mutants ONLY in stage 4. FIRST LINE, do not continue after progression
- Crizotinib - FIRST LINE for ALK+
- May also use bevacizumab, Cetuximab
**Squamous: Cisplatin + Gemcitabine
**Non-squamous: Cisplatin + Pemetrexed
Use radiation for palliative care |
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Term
| Should any agent be continued after disease progression is noted in NSCLC? |
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Definition
| - Only Erlotinib in EGFR+ who have experienced regressions |
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Term
| What are 2nd line agents for NSCLC? |
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Definition
After progression is noted:
Single agent docetaxel, pemetrexed, or erlotinib.
- Docetaxel > vinorelbine/ifosfamide |
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Term
| How is cisplatin/carboplatin used for NSCLC? |
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Definition
- Cis - Hydrate before, during, and after
- Cis - Causes ototoxicity
- Cis - Premeds for N/V
- Carbo - dose based on AUC and GFR. Give after paclitaxel |
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Term
| How is pemetrexed used for NSCLC? |
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Definition
- ONLY for NONsquamous NSCLC
- Give folic acid daily and IM B12 every 3 cycles
- Pretreat w/ dexamethasone to avoid rash. Avoid in CrCl < 45, NSAIDs |
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Term
| How is paclitaxel used for NSCLC? |
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Definition
- Radiosensitizing!
- Give Cisplatin AFTER paclitaxel - avoids more myelosuppression
- H2 antagonist, steroid, benadryl premed due to Cremophor |
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Term
| What targeted tx are used for NSCLC? |
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Definition
- Bevacizumab - advanced non-squamous. Blocks VEGF. CANNOT GIVE W/ HX of HEMOPTYSIS, Anticoag
- Cetuximab - recurrent carcinoma. BENEFITS SLIGHT
- Erlotinib - EGFR+. MONOTHERAPY for tx failure, metastases, recurrence. Don't test in squamous
- Crizotinib - ALK+. Hepatotoxicity, Pneumonitis, QT prolong, vision disorder |
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Term
| What must be monitored when giving Erlotinib? |
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Definition
INR elevations - monitor w/ warfarin patients
Exfoliative skin disorders
Rash - a sign of improved survival |
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Term
| What are Erlotinib clinical predictors? |
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Definition
Higher response rate:
- Never smoked
- Asian
- Women
- Adenocarcinoma
- Rash |
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Term
|
Definition
- Aggressive and rapid, early metastasis
- 98% from smoking
- Very sensitive to chemo and radiation
- myc family of oncogenes |
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Term
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Definition
- Limited - no metastasis. Chemo + radiation
- Extensive - T3-4, metastasis. Radiation alone
- Extensive + brain metastasis - chemo given after radiation to the brain |
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Term
| What is tx of choice for SCLC? |
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Definition
- Limited stage/good (0-2) - Cis/carboplatin + Etoposide + radiation
- Extensive - Cisplatin + Etoposide
- Prophylactic Cranial Irradiation - recommended for limited/extensive stage w/ complete or partial response
**Max 4-6 cycles |
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Term
| How is etoposide used for SCLC? |
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Definition
| Alters the effect of warfarin by prolonging INR |
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