Neoadjuvant
-chemotherapy given PRIOR to surgical resection
Adjuvant
-chemotherapy given after surgical resection
square root of: Ht(cm) x Wt (kg)/3600
BSA formula?
CTCAE
-is a standardized system for grading and reporting the severity of adverse effects (side effects or toxicities) of medical treatments
b
Informs us of therapeutic efficacy.
a) Prognostic Biomarker
b) Predictive Biomarker
a
Informs us of patient survival independent of treatment received.
a) Prognostic Biomarker
b) Predictive Biomarker
cisplatin + pemetrexed x 4 cycles
What is the chemotherapy treatment for Nonsquamous?
cisplatin + gemcitabine x 4 cycles OR cisplatin + docetaxel x 4 cycles
What is the chemotherapy treatment for Squamous? (2)
AUC x (GFR + 25)
Carboplatin dosing?
(140-age) x (kg)/72 x serum creatine * 0.85 (if female)
Cockcroft-Gault Equation?
atezolizumab(every 2-4 weeks for 1 year) or pembrolizumab (every 3-6 weeks for 1 year)
Which treatments do we use if PD-L1> 1% or ALK rearrangements are present? (2)
osimertinib 80mg; QD for 3 years
Which treatments do we use if EGFR mutation is present?
endocrinopathy
If ________ develops, it will not go away.
hold dose of immunotherapy & resume once symptoms resolve
If a low-grade AE (1) occurs, what treatment options do we have? *IMMUNOTHERAPY
prednisone until ADE resolved then slowly taper; hold immunotherapy
If moderate grade (2-3) occurs, what treatment options do we have?
*IMMUNOTHERAPY
steroids + consider infliximab; discontinue immunotherapy
If severe grade (4) occurs, what treatment options do we have?
*IMMUNOTHERAPY
surgery, neo/adjuvant chemo, chemoradiation, consolidation therapy
What are the treatment options for Stage: III ? (4)
a
EGFR positive.
a) osimertinib
b) immunotherapy
c) sotorasib
d) systemic chemotherapy
b
PD-L1>1%
a) osimertinib
b) immunotherapy
c) sotorasib
d) systemic chemotherapy
d
No mutations are present.
a) osimertinib
b) immunotherapy
c) sotorasib
d) systemic chemotherapy
asians
EGFR mutations are most common in ________.
d
When is mandatory for patients to have molecular testing done?
a) Stage I NSCLC
b) Stage II NSCLC
c) Stage III NSCLC
d) Stage IV NSCLC
platinum doublet + nivolumab x 3 cycles
What is our Neoadjuvant chemo regimen? *STAGE 3
platinum doublet x 4 cycles
What is our Adjuvant Chemotherapy regimen? *STAGE 3
platinum doublet + radiation
What is our Chemoradiation regimen? *STAGE 3
durvalumab up to 1 year
What is our Consolidation therapy? *STAGE 3
adenocarcinoma, large cell
What are our Non-Squamous Cancers? (2)
PD-L1> 1%, ALK rearrangement, EGFR mutation
When is Adjuvant targeted therapy indicated? (3)
surgery
What is the treatment for Stage 1?
surgery + adjuvant chemotherapy ( if nodal involvement); radiation
What is the treatment for Stage 2?
What if there are positive margins?
after 2 or more cycles of chemoradiation + good response
When is consolidation therapy indicated? (2)
cure; prevent progression
What is the goal of Stage 3?
not curable; slow disease progression
What is the goal of Stage 4?
PD-L1, EGFR, ALK
What tests are used for Non-Squamous cell: Stage 4? (3)
PD-L1
Which test is used for Squamous cell: Stage 4?
EGFR positive + Stage IV
When can Osimertinib be started 1st line?
PD-L1 >= 50%
When can immunotherapy be used as monotherapy?
ECOG: 0-1= platinum analog + pemetrexed + pembrolizumab
Treatment for Stage IV: Non-Squamous +NO Mutation?
ECOG: 0-1= carboplatin + abraxane + pembrolizumab
Treatment for Stage IV: Squamous cell + No mutation?
platinum doublet
ECOG: 2 will always have what treatment?