Lung Cancer

Lung Cancer

"Life Is Either A Daring Adventure Or Nothing At All" - Helen Keller
Lung Cancer Part 1

How is ALK diver mutation diagnosed ?

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FISH or IHC

Lung Cancer Part 1
Lung Cancer Part 1

Do ALK inhibitors have good central nervous system penetration?

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Yes, with alectinib shown to be the best

Lung Cancer Part 1
Lung Cancer

What percentage reduction in brain recurrence of brain metastases can be seen in in small cell lung cancer patient after whole brain radiation prophylaxis?

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50%

Lung Cancer
lung cancer

Which lung cancers have the highest and least number of brain metastases?

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Adenocarcinoma most,
Squamous cell carcinoma least

lung cancer
Lung Cancer

What are the 4 most common metastatic sites for lung cancer?

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Bone, brain, liver, adrenal glands

Lung Cancer
Lung Cancer

Are non-small cell lung cancer bone metastases lytic or blastic?

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Lytic

Lung Cancer
Lung Cancer

Which type of lung cancer is the leading cause of pancoast tumors?

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Small cell lung cancer

Lung Cancer
Lung Cancer

What does a Pancoast tumor present as?

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Shoulder pain, Horner’s syndrome, and muscle atrophy

Lung Cancer
Lung Cancer

What are the signs and symptoms of superior vena cava syndrome?

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Prominent chest veins, facial edema, neck distention

Lung Cancer
Lung Cancer

How does the positive cytology of a pleural effusion change non-small cell lung cancer staging?

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Stage IVA

Lung Cancer
Lung Cancer

How do the 2 different types of pleural extension determine the T stage of non-small cell lung cancer?

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Visceral T2 & Parietal T3

Lung Cancer
Lung Cancer

Which 2 types of lung cancer present with cough?

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Squamous cell and small cell

Lung Cancer
Lung Cancer

Which 2 cancers types are more central rather than peripheral ?

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Squamous cell and small cell

Lung Cancer
Lung Cancer

What are the top 2 presenting symptoms of lung cancer?

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Cough, dyspnea, pain

Lung Cancer
Lung Cancer

What percentage of white patients versus Asian patients have EGFR driver mutation lung cancer?

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20% versus 40%

Lung Cancer
Lung Cancer

What other risk factors are there besides smoking for lung cancer?

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Asbestos, radiation exposure, secondhand smoke, nickel, chromium, silver, radon, polycythemic aromatics

Lung Cancer
Lung Cancer

Which autoimmune disease poses an increased risk of developing non-small cell lung cancer?

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IPF

Lung Cancer
Lung Cancer

How many-fold increase in lung cancer incidence is there in a patient with a 40-pack-year smoking history versus a nonsmoker?

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20-fold increase

Lung Cancer
Lung Cancer

Who should get adjuvant radiotherapy for stage I and 2 non-small cell lung cancer status post resection with R0 resections?

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None of them

Lung Cancer
lung cancer

Which patients do not require adjuvant chemotherapy with non-small cell lung cancer?

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Stage IA only

lung cancer
lung cancer

What is the size cut-off for stereotactic radiotherapy versus standard radiotherapy for nonsurgical candidates with stage I and II non-small cell lung cancer?

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5cm

lung cancer
Lung Cancer

What is the preferred treatment for stage I and 2 non-small cell lung cancer?

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Lobectomy

Lung Cancer
Lung Cancer

What must be ruled out prior to any treatment for stage I or stage II non-small cell lung cancer?

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Mediastinal lymphadenopathy

Lung Cancer
Lung Cancer

How often should you screen high-risk patients for lung cancer if they qualify?

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Once per year

Lung Cancer
Lung Cancer

What are the criteria for lung cancer screening?

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Age 55-75, at least a 30-pack-year smoking history, quitting within the last 15 years

Lung Cancer
Lung Cancer

How is a lung cancer screening CT protocol different from a regular CT scan?

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Low dose radiation (1/3rd the dose)

Lung Cancer
lung cancer

Which of the first-generation EGFR TKIs are most active in brain metastases?

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Gefitinib and erlotinib

lung cancer
Lung Cancer

Which treatment modality does not affect PFS or OS in stage IV non-small cell lung cancer with brain metastases?

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Whole brain radiotherapy

Lung Cancer
Lung Cancer

Which is the first-generation ALK inhibitor?

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Crizotinib

Lung Cancer
Lung Cancer

Which 2 other cancers that are in the patient’s history increase the risk of developing LC?

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Hodgkin’s disease and breast cancer 2/2 XRT exposure

Lung Cancer
Lung Cancer

When is it accepted to continue with a TKI when there is evidence of disease progression and non-small cell lung cancer?

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If there is isolated local recurrence

Lung Cancer
Lung Cancer

Which chemotherapy should be used as the backbone of cytotoxic therapy for stage IV squamous cell carcinoma of the lung?

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Platinum based

Lung Cancer
Lung Cancer

Which stage IV NSCLC patients would not be candidates for pemetrexed?

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Squamous cell histology

Lung Cancer
Lung Cancer

For non-small cell lung cancer in the adjuvant setting, how many platinum-based chemotherapy cycles should be given?

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4-6

Lung Cancer
lung cancer

What is the ideal sequence of maintenance chemotherapy and targeted therapy for patients that have already started chemotherapy with stage IV non-small cell lung cancer with a driver mutation?

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There is no superiority with any sequence

lung cancer
lung cancer

When would you consider combined oral TKI with chemotherapy for early stage non-small cell lung cancer?

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Never

lung cancer
lung cancer

What 2 criteria would argue against adjuvant surgical resection for N2 NSCLC?

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If a right-sided pneumonectomy is required and there is mediastinal bulkiness

lung cancer
Lung Cancer

Is there a survival advantage with surgery for patients with mediastinal involvement and non-small cell lung cancer after concurrent chemotherapy and radiotherapy?

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Unclear data

Lung Cancer
Lung Cancer

If a patient has confirmed N2 disease for non-small cell lung cancer, what is first-line treatment?

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Concurrent chemoradiotherapy followed by 1 year of PDL1 directed therapy

Lung Cancer
Lung Cancer

How is adjuvant chemotherapy and radiotherapy sequenced with respect to positive margins in stage III non-small cell lung cancer?

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Chemotherapy first

Lung Cancer
Lung Cancer

Is there a role for radiotherapy in the adjuvant setting for carcinoma in situ with positive margins for non-small cell lung cancer?

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Unclear

Lung Cancer
lung cancer

How are adjuvant chemotherapy and radiotherapy administered in stage III non-small cell lung cancer?

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Sequentially with chemotherapy first

lung cancer
lung cancer

What are the criteria for adjuvant radiotherapy in stage III non-small cell lung cancer?

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Confirmed mediastinal disease, positive margins, inadequate mediastinal lymph node sampling during surgery

lung cancer
Lung Cancer

Which subset of stage III lung cancer patients benefit from adjuvant radiotherapy?

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N2 patients. N0/N1 have not shown benefit in meta-analysis

Lung Cancer
Lung Cancer

Which stage IV lung cancer is potentially curable with surgery and adjuvant chemotherapy?

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Contralateral mediastinal/hilar lymph nodes
Contralateral and ipsilateral scalene or supraclavicular lymph nodes

Lung Cancer
Lung Cancer

Which non-small cell lung cancer stage IIIa subset should be considered for neoadjuvant chemo-radiotherapy before surgery?

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T3N1 and T4N1 superior sulcus tumors

Lung Cancer
Lung Cancer

Which subset of stage IIIA NSCLC has the best outcomes?

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T3N1 because it is not N2 and hence resectable

Lung Cancer
Lung Cancer Part 2

How are chemotherapy and radiotherapy administered in the adjuvant setting for clinical stage I lung cancer?

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If positive resection margin and up to N2 disease, then given sequentially not concurrently

Lung Cancer Part 2
Lung Cancer

Who should receive adjuvant radiotherapy for early stage I and stage II lung cancer?

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Positive resection margins

Lung Cancer
Lung Cancer

What is the role of neoadjuvant chemotherapy for stage I and stage II non-small cell lung cancer?

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Unclear – adjuvant therapy is the standard of care

Lung Cancer
Lung Cancer

Who should not get adjuvant chemotherapy for early stage lung cancer?

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stage IA-never give chemo

Lung Cancer
Lung Cancer

What role is there for concurrent chemotherapy and radiotherapy for stage I and II lung cancer who are surgical candidates?

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No role

Lung Cancer
Lung Cancer

What type of radiotherapy is preferred for stage I peripheral lung cancer lesions?

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SBRT

Lung Cancer
Lung Cancer

Which lymph node stations should be sampled for proper staging?

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Right-sided 4,7,10
Left-sided 5,6,7

Lung Cancer
Lung Cancer

What is the role of intraoperative brachytherapy with iodine-131?

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No role

Lung Cancer
Lung Cancer

Tumors of what size in non-small cell lung cancer have similar efficacy with regards to wedge resection and lobectomy?

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2 cm

Lung Cancer
Lung Cancer

Which early-stage lung cancer patients should get adjuvant radiotherapy?

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“Positive margins

Lung Cancer
Lung Cancer

Which early-stage lung cancer patients should not be offered adjuvant chemotherapy?

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Stage IA

Lung Cancer
Lung Cancer

For stage I non-small cell lung cancer following resection what criteria should be met for adjuvant chemotherapy?

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Positive margins, stage IB, IIA, IIB, mediastinal lymph node involvement, upstaging to stage III

Lung Cancer
Lung Cancer

What makes non-small cell lung cancer resectable?

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Lack of mediastinal involvement and single-sided tumor

Lung Cancer
Lung Cancer

What defines N1 disease in NSCLC TNM staging?

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Ipsilateral, hilar or peribronchial lymph nodes

Lung Cancer
Lung Cancer

What defines N2 disease in NSCLC TNM staging?

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Ipsilateral mediastinal or subcarinal lymph nodes

Lung Cancer
Lung Cancer

What defines N3 disease in non-small cell lung cancer?

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Contralateral mediastinal/hilar lymph nodes
Contralateral and ipsilateral scalene or supraclavicular lymph nodes

Lung Cancer
Lung Cancer

What size cut-offs distinguish T1, 2, 3 lesions in NSCLC ?

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T2 is 3-5cm

Lung Cancer
Lung Cancer

What defines NSCLC T4?

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Invasion into the carina, heart, mediastinum, trachea, great vessels, esophagus, recurrent laryngeal nerve, vertebral body, 2 different lesions in the ipsilateral lobe

Lung Cancer
Lung Cancer

What stains are positive for carcinoid tumor?

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CD56, synaptophysin, chromogranin, NSE

Lung Cancer
Lung Cancer

What are the histologic features of small cell lung cancer?

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Small cells, blue cells, high crush artifact, high nuclear to chromatin ratio, hyperchromatic record appearance

Lung Cancer
Lung Cancer

What chemotherapy can be given to elderly patients with advanced small cell lung cancer?

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Carboplatinum and etoposide

Lung Cancer
Lung Cancer

How many cycles of chemotherapy should be used for extensive stage small cell lung cancer?

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4–6

Lung Cancer
Lung Cancer

What alternating chemotherapy regimens are active in extensive stage small cell lung cancer?

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CAV/PE and CDE/VMP

Lung Cancer
Lung Cancer

What agents are active in small cell lung cancer?

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Platinum agents, irinotecan, anthracycline, paclitaxel, docetaxel, cyclophosphamide, ifosfamide

Lung Cancer
Lung Cancer

What class of chemotherapy agents can be substituted for etoposide for extensive stage small cell lung cancer?

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Irinotecan and topotecan

Lung Cancer
Lung Cancer

Which chemotherapy combination is first-line for non-small cell lung cancer?

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Platinum-based doublet usually with etoposide

Lung Cancer
Lung Cancer

When is radiotherapy to a thoracic lesion a reasonable option in advanced small cell lung cancer?

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If a good response is seen with doublet chemotherapy

Lung Cancer
Lung Cancer

Which CK marker is positive by IHC in lung cancer but negative in colon cancer

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CK7

Lung Cancer
Lung Cancer

What is the IHC pattern for squamous cell carcinoma of the lung?

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P63 and CK 5/6/7 +

Lung Cancer
Lung Cancer

What is the IHC pattern for adenocarcinoma non-small cell lung cancer?

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TTF-1, Mucin, Napsin-A, Surf-A, Surf-B

Lung Cancer
Lung Cancer

What is the IHC pattern for small cell lung cancer?

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TTF-1 positive, chromogranin positive, synaptophysin positive

Lung Cancer
Lung Cancer

What histologic features of adenocarcinoma are seen for non-small cell lung cancer?

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Glands

Lung Cancer
Lung Cancer

What histologic feature is seen on large cell lung cancer?

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No glands and no keratin

Lung Cancer
Lung Cancer

What are the features on histology for small cell lung cancer?

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Positive keratin staining
± Intracellular desmosomes

Lung Cancer
Lung Cancer

Which stage lung cancer should get a routine brain MRI or CT scan?

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Stage III and stage IV

Lung Cancer
Lung Cancer

What is the most important utility of properly staging with a PET/CT for non-small cell lung cancer?

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Avoiding futile thoracotomy because this worsens overall survival

Lung Cancer
Lung Cancer

What lymph node size cut-off is used for diagnosing lymphadenopathy on staging imaging?

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1 cm

Lung Cancer
Lung Cancer

What is the most common crucial component of properly staging lung cancer?

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Lymph node biopsy, but given high false-negative rate, PET/CT’s acceptable

Lung Cancer
Lung Cancer

What CT scan findings should make lung cancer a suspicious diagnosis besides the presence of nodules and/or lymph nodes?

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Atelectasis and postobstructive pneumonia

Lung Cancer
Lung Cancer

What are some typical presentations for small cell lung cancer versus non-small cell lung cancer?

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Small cell lung cancer–mediastinal lymphadenopathy, rapid progression, SVC syndrome, SIADH, brain metastases, bone metastases

Non-small cell lung cancer – hypercalcemia, Pancoast tumors

Lung Cancer
Lung Cancer

What is the typical doubling time for lung cancer ?

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90-180 days

Lung Cancer
Lung Cancer

What clinical stages of lung cancer warrant PET/CT?

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Stage IA to stage III a

Lung Cancer
Lung Cancer

What autoimmune dermatologic conditions can be seen with lung cancer?

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Dermatomyositis & Polymyositis

Lung Cancer
Lung Cancer

Where does hypertrophic osteoarthropathy manifest?
Ankle, wrist, elbow, knee

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Lung Cancer
Lung Cancer

What endocrine syndrome can develop with lung cancer?

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Cushing syndrome

Lung Cancer
Lung Cancer

What hypercoagulable change can be seen with lung cancer?

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Trousseau syndrome with migratory superficial thrombophlebitis, deep venous thrombosis, DIC, thrombotic microangiopathy, nonthrombotic microangiopathy

Lung Cancer
Lung Cancer

What 7 different central nervous system paraneoplastic syndromes can be caused by lung cancer?

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Eaton Lambert Syndrome, cerebellar ataxia, sensory neuropathy, limbic encephalitis, encephalomyelitis, autonomic neuropathy, retinopathy, opsomyoclonus

Lung Cancer
Lung Cancer

Which lung cancer causes SIADH?

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Small cell lung cancer

Lung Cancer
Lung Cancer

Which lung cancer causes the most hypercalcemia?

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Squamous cell carcinoma

Lung Cancer
Lung Cancer

What are the 2 mechanisms of hypercalcemia in lung cancer?

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Calcium release from bone metastases and PTHrP release from the tumor

Lung Cancer
Lung Cancer Part 3

Is adjuvant radiotherapy indicated in N2 disease for NSCLC patients ?

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Yes

Lung Cancer Part 3
Lung Cancer

In stage 2 NSCLC who undergo R1 resection, is there a role for chemotherapy atop radiotherapy ?

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Yes

Lung Cancer
Lung Cancer

IS there a survival advantage for platinum-based chemotherapy for stage IB non-small cell lung cancer in the adjuvant setting?

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Yes, in the presence of high risk features

Lung Cancer
Lung Cancer

What are the adjuvant options for stage IB lung cancer?

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Platinum doublet chemotherapy versus observation

Lung Cancer
Lung Cancer

What is the size cut off for SBRT in stage II NSCLC ?

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SBRT is only for lesions smaller than 5 cm

Lung Cancer
Lung Cancer

What is the role of EGFR and ALK TKI in stage I and stage II non-small cell lung cancer after resection?

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None

Lung Cancer
Lung Cancer

What is the target of necitumumab?

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EGFR

Lung Cancer
Lung Cancer

What is the role of Cetuximab in SCLC ?

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No approved indication

Lung Cancer
Lung Cancer

What is the most worrisome side effect with Brigatinib?

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lung toxicity – 10%

Lung Cancer
lung cancer

What cardiac diagnostic studies are initially required with brigatinib ?

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EKG

lung cancer
Lung Cancer

Which ALK inhibitor causes renal cysts ?

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brigatinib

Lung Cancer
Lung Cancer

Which ALK inhibitor has the best central nervous system penetration?

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Alectinib

Lung Cancer
Lung Cancer

In what situation is erlotinib plus bevacizumab indicated in the first line setting for lung adenocarcinoma ?

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None – no OS demonstrated

Lung Cancer
Lung Cancer

In what situation is pemetrexed plus erlotinib indicated as maintenance in lung adenocarcinoma?

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None – no OS demonstrated

Lung Cancer
Lung Cancer

Which EGFR targeting TKI has the best central nervous system response?

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Osimertinib

Lung Cancer
Lung Cancer

What are the 2 mechanisms of EGFR resistance?

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T790M and MET amplification

Lung Cancer
Lung Cancer

How does gefitinib compare to chemotherapy in non-EGFR non-small cell lung cancer?

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Inferior

Lung Cancer
Lung Cancer

What did the clinical trials with gefitinib versus first-line chemotherapy reveal ?

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Increased progression free survival with no change in overall survival

Lung Cancer
Lung Cancer

What did the FLAURA clinical trial show for osimertinib vs erlotinib and gefitinib?

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Increased progression free survival and increased duration of response

Lung Cancer
Lung Cancer

Which demographic has the highest EGFR driver mutated lung cancer?

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Asian females

Lung Cancer
Lung Cancer

Which molecular pathways is amplified by EGFR?

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RAS/RAF

Lung Cancer
Lung Cancer

What are the 3 common mutations that drive EGFR NSCLC?

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Exon 21 L858R/Q and Exon 19 deletion

Lung Cancer
Lung Cancer

What is the major side effect with Crizotinib in men?

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hypotestosteronemia

Lung Cancer
Lung Cancer

What transformation can be seen in non-small cell lung cancer with an EGFR driver mutation that progresses on oral therapy?

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Small cell transformation

Lung Cancer
Lung Cancer

What other protein is targeted by afatinib besides EGFR?

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Her2

Lung Cancer
Lung Cancer

Which mutation leads to EGFR TKI resistance?

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T790M

Lung Cancer
Lung Cancer

Is contralateral hilar lymph node involvement N2 or N3?

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N3

Lung Cancer
Lung Cancer

Does maintenance pemetrexed improve overall survival?

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Yes

Lung Cancer
Lung Cancer

When would you consider adjuvant radiotherapy following surgery for early stage non-small cell lung cancer?

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R1

Lung Cancer
Lung Cancer

What clinical stage is a patient with 2 nodules in the same lobe and N0 disease?

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Stage II

Lung Cancer
Lung Cancer

With 3 proteins does crizotinib target?

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“ALK

Lung Cancer
Lung Cancer

Which histology of non-small cell lung cancer has a low incidence of ALK mutations?

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Squamous cell carcinoma

Lung Cancer
Lung Cancer

Which mutation is common in small cell lung cancer?

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cKIT

Lung Cancer
Lung Cancer

What does the data show for oral EGFR targeted agents for second or third line treatment versus chemotherapy?

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Worse outcomes with oral agents versus single agent chemo

Lung Cancer
Lung Cancer

What antibodies targeting VEGF/EGFR are approved for second line stage IV non-small cell lung cancer?

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Ramucirumab and necitumumab

Lung Cancer
Lung Cancer

When is it possible to re-challenge a stage IV non-small cell lung cancer with the same chemotherapy agent?

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Positive response and stable disease for at least 6 months

Lung Cancer
Lung Cancer

When can you combine EGFR targeting TKIs with chemotherapy for stage IV non-small cell lung cancer?

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Never, no improvement in survival with added toxicity

Lung Cancer
Lung Cancer

When should you switch from doublet chemotherapy to another doublet chemotherapy in stage IV non-small cell lung cancer?

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Never, no improvement in overall survival

Lung Cancer
Lung Cancer

What single agent cytotoxic agents are active in stage IV non-small cell lung cancer?

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Gemcitabine, paclitaxel, vinorelbine, topotecan, irinotecan

Lung Cancer
Lung Cancer

Which single-agent chemotherapy is preferred for stage IV non-small cell lung cancer who progresses on immunotherapy?

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Pemetrexed or docetaxel

Lung Cancer
Lung Cancer

If a patient with a driver mutation in EGFR, progresses on several lines of oral therapy, what chemotherapy should be considered?

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Platinum-based doublet chemotherapy or pemetrxed +/- bevacizumab

Lung Cancer
Lung Cancer

What treatment options are available for first line stage IV adenocarcinoma of the lung without a driver mutation?

Immunotherapy, chemotherapy, VEGF targeting therapy

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Lung Cancer
Lung Cancer

What advantages are there to the addition of bevacizumab to stage IV non-small cell lung cancer?

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Improvement in progression free survival

Lung Cancer
Lung Cancer

Which combination chemotherapy regimens have been studied for stage IV non-small cell lung cancer?

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Carboplatin and paclitaxel
Pemetrexed and carboplatin
Gemcitabine and vinorelbine

Lung Cancer
Lung Cancer

Which 2 chemotherapy agents can be given as a single agents for stage IV non-small cell lung cancer?

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Docetaxel and vinorelbine

Lung Cancer
Lung Cancer

What treatment option is there for low performance status stage III non-small cell lung cancer patients that is not resectable?

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Definitive radiotherapy or palliative radiotherapy

Lung Cancer
Lung Cancer

When should one use prophylactic whole brain radiation for stage III non-small cell lung cancer?

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Not indicated

Lung Cancer
Lung Cancer

What is the data on the use of EGFR targeting agents in stage III non-small cell lung cancer?

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Not indicated

Lung Cancer
Lung Cancer

What survival advantages are there for consolidative chemotherapy after concurrent chemotherapy and radiotherapy for stage III non-small cell lung cancer?

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No survival advantage

Lung Cancer
Lung Cancer

Is there a role for induction chemotherapy prior to radiotherapy or concurrent chemoradiotherapy for non-small cell lung cancer?

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If the radiation field is too large

Lung Cancer
Lung Cancer Part 4

What did the AVAii trial assess in NSCLC ?

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cisplatin + gemcitabine with either placebo or bevacizumab as first-line nonsquamous NSCLC

Lung Cancer Part 4
Lung Cancer

What did the PointBreak trial assess in NSCLC ?

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pemetrexed plus carboplatin and bevacizumab followed by maintenance pemetrexed and bevacizumab versus paclitaxel plus carboplatin and bevacizumab followed by maintenance bevacizumab in patients with stage IIIB or IV nonsquamous non-small-cell lung cancer

Lung Cancer
Lung Cancer

Was a PFS or OS shown in the PRONOUNCE trial ?

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No

Lung Cancer
Lung Cancer

What did the IMPower 130 trial assess in NSCLC ?

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Atezolizumab added to carboplatin/nab-paclitaxel in first line advanced non-squamous NSCLC

Lung Cancer
Lung Cancer

Has an OS or pFS been demonstrated in the IMPower 130 trial in NSCLC ?

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Yes, OS

Lung Cancer
Lung Cancer

What did the PRONOUNCE trial assess in NSCLC ?

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irst-line pemetrexed + carboplatin followed by maintenance pemetrexed versus paclitaxel + carboplatin + bevacizumab followed by maintenance bevacizumab in patients ith advanced nonsquamous non-small-cell lung cancer

Lung Cancer
Lung Cancer

Does the addition of atezolizumab improve first-line OS in patients with non-squamous NSCLC when added to carboplatin/paclitzel/bevacizumab ?

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Yes

Lung Cancer
Lung Cancer

What did the IMPower 150 trial assess in NSCLC ?

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OS and PFS when atezolizumab is added to carboplatin/paclitzel/bevacizumab in non-squamous NSCLC

Lung Cancer
Lung Cancer

Has pembrolizumab shown superior OS in first-line SCC NSCLC versus doublet chemo ?

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Yes, KEYNOTE-042

Lung Cancer
Lung Cancer

Did the KEYNOTE-407 trial have maintenance in NSCLC ?

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Yes, with pembrolizumab

Lung Cancer
Lung Cancer

Has an OS been demonstrated in first-line pembrolizumab added to carbo/paclitaxel in first-line SCC NSCLC ?

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Yes, KEYNOTE-407 trial

Lung Cancer
Lung Cancer

Is there data to support the use of pembrolizumab + pemetrexed maintenance after induction chemo/pembro ?

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Yes, KEYNOTE-189 trial

Lung Cancer
Lung Cancer

What did the SQUIRE trial assess in NSCLC ?

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Necitumumab in addition to gem/cis versus gem/cis in first line SCC NSCLC

Lung Cancer
Lung Cancer

Was there a PFS or OS in the ATLAS trial in NSCLC ?

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Only PFS

Lung Cancer
Lung Cancer

What did the ATLAS trial assess in NSCLC ?

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Erlotinib + bevacizumab maintenance versus bevacizumab after induction chemo/bev in advanced first line NSCLC

Lung Cancer
Lung Cancer

How does bev maintenance compare to pemetrex/bev maintenance in the AVAPERL study in NSCLC ?

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Inferior PFS

Lung Cancer
Lung Cancer

What did the AVAPERL study assess in NSCLC ?

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bev maintenance versus pemetrex/bev maintenance after induction with pemetrexed/bev in first line lung adenocarcinoma

Lung Cancer
Lung Cancer

What is the only therapy docetaxel has been shown to be superior to in the second-line setting ?

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Erlotinib

Lung Cancer
Lung Cancer

What did the REVEL trial assess in NSCLC ?

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Ramucirumab + docetaxel versus docetaxel in second line advanced NSCLC

Lung Cancer
Lung Cancer

What the REVEL trial reveal in NSCLC ?

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Superiority of Ramucirumab added to docetaxel in the second-line setting for advanced NSCLC

Lung Cancer
Lung Cancer

What did the ECOG-ACRIN 1512 trial assess in NSCLC ?

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Addition of cabozantinib to erlotinib in EGFR wild-type NSCLC improves PFS versus erlotinib alone

Lung Cancer
Lung Cancer

Which trials assessed the utility of atezolizumab in progressive NSCLC ?

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OAK and POPLAR

Lung Cancer
Lung Cancer

What are the only regimens against which docetaxel has shown a potential improvement in OS in later-line advanced NSCLC ?

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Supportive care, topotecan

Lung Cancer
Lung Cancer

Has nivolumab shown an improvement in OS for advanced NSCLC progressing after first line therapy ?

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Yes, CheckMate-017 and -057

Lung Cancer
Lung Cancer

Has pembrolizumab shown an OS in the second line setting for advanced NSCLC ?

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Yes, KEYNOTE-010 versus docetaxel

Lung Cancer
Lung Cancer

Which phase 3 trial showed an improvement in OS with atezolizumab in progressive NSCLC ?

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OAK

Lung Cancer
Lung Cancer

Which clinical trial showed an improvement in OS for osimertinib versus other TKI in stage IV EGFR mutated NSCLC ?

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FLAURA

Lung Cancer
Lung Cancer

Which EGFR targeting TKI also targets Her2 ?

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Afatinib

Lung Cancer
Lung Cancer

What is the definitive chemoradiotherapy dose for NSCLC ?

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60Gy

Lung Cancer
Lung Cancer

Which non-small cell lung cancer patient should receive whole brain radiotherapy as prophylaxis?

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None of them

Lung Cancer
Lung Cancer

In what clinical situation can you avoid sampling mediastinal lymph nodes for lung cancer staging?

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T1a

Lung Cancer
Lung Cancer

What defines “bulky” mediastinal lymph nodes in non-small cell lung cancer?

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Larger than 2 cm, small lymph node groupings, extracapsular nodal involvement, more than 2 lymph nodes

Lung Cancer
Lung Cancer

Should NSCLC patients with N2 disease receive adjuvant radiotherapy?

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Absolutely

Lung Cancer
Lung Cancer

If stage II and III non-small cell lung cancer patients receive adjuvant radiotherapy after resection is there still a role for chemotherapy?

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Yes

Lung Cancer
Lung Cancer

Is there a survival advantage for platinum-based chemotherapy for stage IB non-small cell lung cancer in the adjuvant setting?

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Yes, in the presence of high risk features

Lung Cancer
Lung Cancer

What are the adjuvant options for stage IB lung cancer?

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Platinum doublet chemotherapy versus observation

Lung Cancer
Lung Cancer

For patients with stage I and stage II NSCLC who are not surgical candidates what determines the use of SBRT versus traditional radiotherapy?

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SBRT is only for lesions smaller than 5 cm

Lung Cancer
Lung Cancer

What is the role of EGFR and ALK TKI in stage I and stage II non-small cell lung cancer after resection?

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None

Lung Cancer
Lung Cancer

What is the protein target of necitumumab?

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EGFR

Lung Cancer
Lung Cancer

What is the role of Cetuximab in NSCLC?

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None

Lung Cancer
Lung Cancer

What ocular changes can be experienced with brigatinib ?

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visual disturbances

Lung Cancer
Lung Cancer

What cardiac side effects can be seen with Crizotinib ?

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QTc prolongation

Lung Cancer
Lung Cancer

What renal adverse event can be seen with ALK inhibitors?

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Renal cyst

Lung Cancer
Lung Cancer

How is ALK diver mutation diagnosed ?

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FISH or IHC

Lung Cancer
Lung Cancer

Which ALK inhibitor has the best central nervous system penetration?

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Alectinib

Lung Cancer
Lung Cancer

In what situation is erlotinib plus bevacizumab maintenance indicated?

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None – no OS demonstrated

Lung Cancer
Lung Cancer

What radiation dose is used in during definitive chemoradiotherapy in NSCLC ?

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6,000 cGy

Lung Cancer
Lung Cancer

Which non-small cell lung cancer patient should receive whole brain radiotherapy as prophylaxis?

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None of them

Lung Cancer
Lung Cancer

Which NSCLC patients can avoid mediastinal LN sampling during staging ?

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T1a

Lung Cancer
Lung Cancer

What are some definitions of bulky N2 disease in NSCLC ?

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Larger than 2 cm, small lymph node groupings, extracapsular nodal involvement, more than 2 lymph nodes

Lung Cancer
Lung Cancer Part 5

Which common OTC medications should be avoided when using selpercatinib ?

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PPI and H2 blockers

Lung Cancer Part 5
Lung Cancer Part 5

 

What are some fusion partners for RET in NSCLC ? 

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KIF5B CCDC6 NCOA4

Lung Cancer Part 5
Lung Cancer Part 5

 

Which pathway is activated by a RET fusion protein ? 

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RAS/RAF/MAPK

Lung Cancer Part 5
Lung Cancer Part 5

 

Is selpercatinib selective for RET ? 

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Yes it has more than 250x specificity

Lung Cancer Part 5
Lung Cancer Part 5

 

Which type of oncogenic RET mechanism is seen in NSCLC vs MTC ? 

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fusion as point mutations are not seen with NSCLC

Lung Cancer Part 5
Lung Cancer Part 5

 

How common is a RET fusion in spontaneous medullary thyroid cancer? 

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60%

 

 

 

Lung Cancer Part 5
Lung Cancer Part 5

 

What types of RET activation have been reported ? 

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Dimerization as well as point mutations

Lung Cancer Part 5
Lung Cancer Part 5

 

How common is a RET fusion in NSCLC ? 

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less than 2%

Lung Cancer Part 5
Lung Cancer Part 5

 

How common is hypertension with use of selpercatinib ? 

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35%

Lung Cancer Part 5
Lung Cancer Part 5

 

Which labs should be monitoring when starting patients with selpercatinib ? 

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 LFT as LFT elevations occurs in more than 50% of patients

Lung Cancer Part 5
Lung Cancer Part 5

What is the target of selpercatinib ? 

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RET

Lung Cancer Part 5
Lung Cancer Part 5

Has an OS been shown in the MAPS trial ?

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Yes

Lung Cancer Part 5
Lung Cancer

What did the MAPS trial assess ?

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Addition of bevacizumab to cisplatin/pemetrexed in advanced mesothelioma

Lung Cancer
Lung Cancer

Did the IMPower 133 trial show an improvement in PFS or OS in SCLC ?

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Both

Lung Cancer
Lung Cancer

What did the Impower133 trial assess in small cell lung cancer ?

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Atezolizumab added to carboplatin/etoposide as first-line treatment in extensive stage small cell lung cancer

Lung Cancer
Lung Cancer

Did the SALUTE trial show an improvement in PFS or OS ?

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Only PFS

Lung Cancer
Lung Cancer

What did the SALUTE trial assess in extensive stage small cell lung cancer ?

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Addition of bevacizumab to cisplatin/etoposide in the first-line setting

Lung Cancer
Lung Cancer

Why did the CALGB 30504 trial not show an OS with sunitinib maintenance for extensive stage small cell lung cancer ?

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Cross-over was allowed

Lung Cancer
Lung Cancer

Has the CASPIAN trial demonstrated an improvement in OS ?

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Yes

Lung Cancer
Lung Cancer

Which chemo doublet has shown superiority over cisplatin/etoposide for first-line extensive stage small cell lung cancer ?

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Cisplatin/irinotecan

Lung Cancer
Lung Cancer

Which trial assessed the utility of curvalumab as maintenance in extensive stage first line small cell lung cancer ?

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CASPIAN

Lung Cancer
Lung Cancer

Which maintenance regimens have shown efficacy in advanced small cell lung cancer ?

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Durvalumab, Atezolizumab, sunitinib

Lung Cancer
Lung Cancer

Which regimens have proven improvements in PFS or OS in second line advanced small cell lung cancer ?

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Cis/etop/irinotecan versus topotecan in platinum sensitive disease
Topotecan versus supportive care

Lung Cancer
Lung Cancer

What has afatinib shown PFS improvements against in NSCLC ?

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Chemo and gefitinib , LUX-LUNG-3,6,7 trials

Lung Cancer
Lung Cancer

What did the ARCHER 1050 trial assess in NSCLC ?

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Dacomitinib in first-line EGFR mutated advanced NSCLC

Lung Cancer
Lung Cancer

Which trials showed the superiority of erlotinib versus chemotherapy for EGFR mutated advanced NSCLC in the first-line setting ?

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EURTAC, OPTIMAL, ENSURE

Lung Cancer
Lung Cancer

Did the RELAY trial show an improvement in PFS or OS in NSCLC ?

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Yes, PFS

Lung Cancer
Lung Cancer

What did the RELAY trial assess in NSCLC ?

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Addition of ramucirumab to erlotinib in first-line EGFR mutated NSCLC

Lung Cancer
Lung Cancer

Is there evidence that adding gefitinib to double chemo can improve OS ?

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Yes, NEJ009 trial

Lung Cancer
Lung Cancer

Was there a PFS or OS advantage with the JMIT trial in NSCLC patients ?

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Yes , PFS, though only a phase 2 trial

Lung Cancer
Lung Cancer

What did the JMIT trial assess in NSCLC ?

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Efficacy of adding pemetrexed to gefitinib in first-line EGFR mutated advanced NSCLC

Lung Cancer
Lung Cancer

Has an OS been demonstrated with osimertinib in first-line EGFR mutated NSCLC ?

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Yes

Lung Cancer
Lung Cancer

Were patients with NSCLC brain mets allowed in the FLAURA trial ?

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Yes

Lung Cancer
Lung Cancer

Which trial assessed the efficacy of Osimertinib in first line EGFR mutated advanced NSCLC ?

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FLAURA

Lung Cancer
Lung Cancer

Which phase 3 trial has demonstrated the superiority of any second-line TKI in EGFR mutated advanced NSCLC ?

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None

Lung Cancer
Lung Cancer

Was an OS or PFS demonstrated with AURA3 for NSCLC ?

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Yes, PFS

Lung Cancer
Lung Cancer

Did the AURA3 trial include in NSCLC patients with brain metastases ?

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Yes

Lung Cancer
Lung Cancer

What did the AURA3 trial assess ?

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Osimertinib versus doublet-chemo in EGFR T790M advanced NSCLC progressing on 1 line of EGFR TKI

Lung Cancer
Lung Cancer

Which Phase 3 trial showed the efficacy of dabrafenib/trametinib for first line BRAF V600 mutated advanced NSCLC ?

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None, only phase 2 data available

Lung Cancer
Lung Cancer

What is the main difference between ALEX and J-ALEX ?

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J-ALEX was in Japanese patients

Lung Cancer
Lung Cancer

What did the J-ALEX and ALEX trials assess in ALK rearranged advanced NSCLC ?

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Alectinib versus crizotinib in the first-line setting

Lung Cancer
Lung Cancer

What were the results of the ALTA-1L trial in NSCLC ?

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Brigatinib is superior to crizotinib

Lung Cancer
Lung Cancer

What did the ALTA-1L trial assess in NSCLC ?

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Brigatinib versus crizotinib as first-line therapy in ALK rearranged advanced NSCLC

Lung Cancer
Lung Cancer

What did the ASCEND-4 trial assess in NSCLC ?

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Efficacy of ceritinib versus chemo in first-line ALK rearranged advanced NSCLC

Lung Cancer
Lung Cancer

What is the difference between the PROFILE 1014 and 1029 trials in NSCLC ?

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PROFILE 1029 was in Asian patients

Lung Cancer
Lung Cancer

Has doublet chemo shown to be superior to single agent chemo for first line treatment of ALK rearranged advanced NSCLC versus crizotinib ?

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No, both single and double agent are inferior to crizotinib

Lung Cancer
Lung Cancer

What was the ALUR trial in NSCLC ?

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Alectinib versus chemo (docetaxel or pemetrexed) for crizotinib – refractory ALK rearranged advanced NSCLC

Lung Cancer
Lung Cancer

What the ALTA trial reveal about brigatinib efficacy for ALK/ROS mutated NSCLC brain metastases ?

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Higher ORR with 160mg/day versus 90mg/day

Lung Cancer
Lung Cancer

What is the most common treatment related AE with lorlatinib in NSCLC ?

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Hypercholesterolemia

Lung Cancer
Lung Cancer

Does lorlatinib have intracranial activity in NSCLC ?

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Yes, from phase 1 trial

Lung Cancer
Lung Cancer

What did the ASCEND-5 trial determine for ALK mutated NSCLC ?

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Pemetrexed is inferior to ceritinib for ALK mutated advanced NSCLC who progressed on chemo and crizotinib

Lung Cancer
Lung Cancer

What did the ASCEND-5 trial assess in ALK mutated NSCLC ?

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Pemetrexed versus ceritinib for ALK mutated advanced NSCLC who progressed on chemo and crizotinib

Lung Cancer
Lung Cancer

What did the ANITA trial assess for NSCLC ?

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Adjuvant cisplatin/vinorelbine after surgery

Lung Cancer
Lung Cancer

What did the IALT trial assess for NSCLC ?

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adjuvant cisplatin/etoposide after surgery

Lung Cancer
Lung Cancer

What did the CHEST trial assess in NSCLC ?

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Neoadjuvant gem/cis versus surgery alone in stage IB to IIIA NSCLC

Lung Cancer
Lung Cancer

What did the PACIFIC trial assess in NSCLC ?

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Durvalumab consolidation after definitive chemoradiotherapy

Lung Cancer
Lung Cancer

What were the results of the AVAii trial in NSCLC ?

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Bevacizumab added PFS but not OS, potentially because of efficacious second line treatments

Lung Cancer
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