Nsclc

Front 1

NSCLC - Genetic susceptibility loci

Back 1

6p21, 15q25

Front 2

Which carry a worse prognosis - mucinous or non mucinous BAC?

Back 2

Mucinous

Front 3

NSCLC - T stage>

Back 3

T1 - <3 (Ia <2, Ib 2-3), T2 - 3-7, (2a 3-5, 2b 5-7), T3 - >7, <2cm carina, invasive, seperate tumor in same lobe

T4 - invasive, carina, different ipsi lobe

Front 4

NSCLC - stage IIIB is? IIIA?

Back 4

IIIB - N3, T4N2

IIIA - T0-3N2, T3-4N1, T4N0

Front 5

NSCLC - stage IIB? IIA? IB?

Back 5

IIB - T3N0, T2bN1

IIA - T2bN0 T1-T2aN1

IB - T2aN0

Front 6

NSCLC - newly diagnosed, which patients should undergo PET?

Back 6

Every newly diagnosed patient

Front 7

NSCLC - EUS can detect lesions in which stations?

Back 7

2,4,5,7,8.

Cannot asses 3 or 6

(3mm)

Front 8

NSCLC - CME can detect lesions at which stations. What are the indications for performing CME and when you can forego it?

Back 8

CME 2,3,4,7,10.

CME indicated for clinical stage II/III, particulary those potentially requiring pneumonectomy.

Forego in clinical stage I if PET negative for mediastinum

Front 9

NSCLC - what is the strategy for sampling a patient who might need induction therapy?

Back 9

EBUS/EUS and if negative CME

Front 10

NSCLC - when do you use VATS?

Back 10

For stations which cannot be assessed by CME, for T4 lesions

Front 11

NSCLC - which patients are classicaly inoperable?

Back 11

N3, T4 (esp. with N2)

Front 12

NSCLC - strategy for screening patients prior to surgery

Back 12

FEV1/DLCO >60% no further testing.

FEV1/DLCO <60% --> V/Q scans to assess postop capacity. Postop capacity <40% --> exercise testing --> predicted VO2 max >15ml/kg can undergo surgery

Front 13

NSCLC -data regarding IMRT?

Back 13

IMRT reduces G3-4 rad pnemo 1y 32%-->8%

V5<70% predictive for greater risk of pneumonitis

Front 14

NSCLC - for early stages, is MLND recommended?>

Back 14

controversial, but book states it does not increase mortality.

Consider for all cancers except small peripheral ones with PET negative medaistinum

Front 15

VATS vs thoractomy regarding results and survival?

Back 15

comparable

Front 16

NSCLC - centrally located tumors (T3 <2cm carina), whats the preferred surgical approach?

Back 16

Sleeve lobectomy (rather than pneumonectomy) -- lower mortality, better QOL

Front 17

NSCLC - minimal N2 vs clinical N2 disease

Back 17

Minimal - single station, microscopic foci not found on clinical staging,

Front 18

NSCLC PORT - PORT meta analysis, Italian and Austrian studies. To whom currently recommended

Back 18

PORT Meta analysis - detremintal effect on survival 2y 55%-->48% (LR rate improved thuogh),

Italian study (stage I) - improved 5yOS 58-->67%

Austrian study (stage I-III) improved 5y recurrence free survival 16-->27%, no OS.

local recurrences improved across trials.

Recommended for positive margins, ECE, inadequate mediastinal resection

Front 19

NSCLC -adjuvant chemo meta-analysis, CI significant for which stages?

Whats the recommeneded regimen?

Back 19

5yOS benefit 5%, CI significant only for II and up

Recommended regimen cis-navelbine(mostly studied)

Front 20

NSCLC - adjuvant chemo IALT - stages, regimens, results

Back 20

I-IIIA, various cis-based, 5yOS 5% 40->45, 7.5yOS NS(!!), but DFS still.

Front 21

NSCLC - adjuvant chemo BR10, stages, regimen, results 5y, 9y

Back 21

IB-II, cis-navelbine, 5yOS 56-->67%, significant only for Ib>4cm.

Note 9yOS and DFS remain significant only for N1 disease

Front 22

NSCLC - adjuvant chemo ANITA, stages, regimen, results

Back 22

IB-IIIA, cis navelbine, 5yOS 8.6% benefit, mOS 20 months!!!! 43-->65m

Front 23

NSCLC -adjuvant chemo CALGB 9633, stages, regimen, results

Back 23

Ib only, carbo-taxol q3w, long follow up no OS or DFS. subset analysis OS benefit for Ib >4cm

Front 24

NSCLC - Neoadjuvant CRT for IIIA/IIIB

Back 24

In general, improve mediastinal clearance and margins but does not affect PFS or OS

Front 25

NSCLC - definitive CRT vs neoadjuvant CRT+surgery for IIIA disease

Back 25

Int 0139 - PFS better for surgery 11->21%

EORTC 08941 found no benefit

Front 26

NSCLC - locally advanced, preferred CRT regimen, benefit

Back 26

Concurrent CRT (2-4 cycles of platinum baesd, 60Gy), benefit in OS 5% at 3y (18-->23%)

Front 27

NSCLC - locally advanced, whats the mOS and 5yOS with CRT?

Back 27

CRT for locally advanced -mOS 17m, 5yOS 20%

Front 28

NSCLC - metastatic, benefit of chemotherapy vs BSC, recommendations by PS

Back 28

Metanalysis - y1OS 9% benefit 20-->29%, mOS benefit 1.5m 4.5-->6m.

PS 0-1 platinum doublet

PS 2 single agent

PS 3-4 BSC

Front 29

NSCLC - metastatic, 4 factors impacting response to chemo

Back 29

PS, Age>70, female, LDH-Calcium-HB

Front 30

NSCLC - metastatic, Cis-navelbine vs Cis, Cis-taxol vs Cis-VP, Cis-gemzar vs taxol-gemzar, carbo-taxol vs taxol

Back 30

Cis-navelbine vs cis 2 months 6->8m

Cis taxol vs cis-vp 2 month 8-10m

Cis gemzar vs taxol gemzar 2 months 7-9m

carbo-taxol vs taxol improved mOS (q3w)

Front 31

NSCLC- metastatic, carbo-taxol weekly or 3-weekly

Back 31

same results, weekly less toxic

Front 32

NSCLC - metastatic TAX 326 taxotere carbo/cis vs cis navelbine

Back 32

Same survival. better QOL and RR for taxotere regimens

Front 33

NSCLC - metastatic, cis-alimta vs cis-gemzar

Back 33

non inferior for general poplulation, for adenocarcinoma alimta benefit 1.5m 10.5-->12m, for SCC alimta detrimental 1.5m 11-->9.5

Front 34

NSCLC -metastatic, carbo-taxol-avastin, cis-gemzar-avastin

Back 34

Avastin improved OS, TTP, RR. note 15 treatment related deatsh and 5 fatal pulmonary hemorrhages. Also more hematologic toxicity with avastin.

Cis-gemzar-avastin no OS benefit

Front 35

NSCLC -metastatic FELX study cis-navelbine-cetuximab

Back 35

OS benefit 1m, more G3-4 diarrhea, rash.

NOT FDA APPROVED in the book.

Front 36

NSCLC - metastatic, exclusions for avastin threapy

Back 36

SCC, brain mets, hemoptysis, PS >1

Front 37

NSCLC -metastatic IPASS study for Gefitinib vs carbo-taxol. Stratification by EGFR mutation

Back 37

Asian patients, light/never smokers. non inferiority trial for PFS. 1yPFS 7-->25% for gefitinib.

EGFR mutants significantly longer PFS, EGFR WT significantly worse PFS with gefitinib.

Front 38

NSCLC - metastatic, old patients and chemotherapy?

Back 38

Still beneficia. data suggests lower doses of platinum doublets are effective.

Front 39

NSCLC - metastatic, 6 cycles vs 4 improve what?

Whats the strategy in the book for assessing response during chemo?

Back 39

TTP. Assess response every 2 cycles

Front 40

NSCLC metastatic - Maintenance therapy with alimta

Back 40

Improves PFS 2m and OS 3m 10-13 in adeno only (patients not progressing after induction)

Front 41

NSCLC metastatic - SATURN study for erlotinib maintenance . Stratification by stable disease or reponse after induction

Back 41

improves RR(12%), improves OS by 1m (11-12) for general population. Patients with SD after induction benefited OS 9.5-->12 but not those with response 12-12.5m.

FDA approved for non progressors, EMEA approved for SD only

Front 42

NSCLC - metastatic, 2nd line therapy, whats approved and whats the benefit?

Back 42

Taxotere, Alimta, oral topotecan - roughly 3m for OS 4.5-->7.5m

Front 43

NSCLC - metastatic, IDEAL-2 trial - RR, speed of response, also results of trial 2nd-3rd line vs BSC

Back 43

2nd-3rd line gefitinib , RR 11%, response within 8 days/. When compared to BSC no benefit in OS or PFS

Front 44

NSCLC -metastatic, BR21 trial erlotinib vs BSC

Back 44

2nd-3rd line, RR 9% vs 1%, OS benefit 2m 4.5-->6.5m

Front 45

NSCLC - metastatic, INTEREST study gefitinib vs docetaxel 2nd line. also stratification by EGFR mutation

Back 45

gefitinib non inferior in RR, OS. better QOL with gefitinib. When stratified by mutation - EGFR mutatnts PFS 3m advantage 4-7m

Front 46

NSCLC - EGFR relation with KRAS, ALK. response by specific mutations

Back 46

EGFR mutation mutually exclusive with KRAS or ALK mutation. Exon 19del better response and survival than L858R exon 21.