lung cancer

non-small cell lung cancer vs small cell lung cancer

• small cell

  • mostly with smokers

  • more towards middle

  • chemo > surgery

• non-small

  • around periphery

  • surgery > chemo

risk factors for lung cancer include…

• tobacco smoke

• family/personal history

• chemical/radiation exposures

• air pollution

A 72 year old patient is wondering if he should undergo screening for lung cancer. He has a 15 pack-year history although he quit 7 years ago. Should the patient be screened?

no

when to screen a patient?

• 50-80 years old

• in fairly good health

• current smoker or used to smoke

AND

• at least a 20-pack year history

early stage lung cancer (I-III) will always have what type of agent

• platinum agent

what toxicities are associated with cisplatin?

• renal toxicity

• ototoxicity

• peripheral neuropathy

cisplatin counseling

• needs hydration

  • saline diuresis before and after infusion

• delayed hypersensitivity reaction

  • 6th-8th cycle

what specific population is the best with EGFR inhibitors

• Asian, female, non-smoker

when to start targeted therapy?

• metastatic cancer with mutation

when to start ICI?

• metastatic cancer with no mutation

• no contraindication

when to start cytotoxic chemo alone

• metastatic cancer with no mutation

• contraindication to ICI

what is an immune check inhibitor (ICI)?

• unmask tumors

  • attach to PD-1 or PD-L1 to reveal tumor to immune system

what are the adverse effects of ICI’s

• -itis

  • dermatitis

  • colitis/diarrhea

  • hepatitis

  • hypophysitis

• type 1 diabetes

• hypothyroidism

what type of ADE of ICIs are irreversible?

• endocrine-related

  • type-1 diabetes

  • hypothyroidism

what to do if there are grade 1 toxicities with ICIs?

• continue therapy with close monitoring

  • except if neurologic, hematologic, cardiac toxicities = STOP tx

what to do if there are grade 2 toxicities with ICIs?

• hold therapy and resume when symptoms are grade 1 or less

• low dose corticosteroid (0.5-1 mg/kg/day)

what to do if there are grade 3 toxicities with ICIs?

• hold therapy and initiate high dose steroids (1-2 mg/kg/day)

• rechallenge when grade 1 toxicity; no dose changes

what to do if there are grade 4 toxicities with ICIs?

• permanent discontinuation

T/F: long time use of prednisone needs to be tapered down (~3 months)

• true

what should you monitor in a patient who is receiving cisplatin?

a) constipation

b) renal function

c) acneiform rash

d) hepatotoxicity

b) renal function

how to treat SCLC

• limited stage (4 cycles)

  • plt + etoposide + XRT

• extensive stage (4-6 cycles)

  • plt + etoposide + atexolixumab or durvalumab

which of the following ADE would commonly NOT be seen with immune checkpoint inhibitors?

a) diarrhea

b) rash

c) nausea

d) hepatotoxicity

c) nausea