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What is the significance of EGFR mutations in NSCLC?
these mutations increase effectiveness of Tyrosine Kinase Inhibitors (erlotinib, gefitinib)
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What is the significance of K-ras mutations in NSCLC?
these mutations decrease the effectiveness of Tirosine Kinase Inhibitors (erlotinib, gefitinb)
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What drugs are used to treat NSCLC?
- Bevacizumab
- Carboplatin
- Cetuximab
- Cisplatin
- Docetaxel
- Erlotinib
- Etoposide
- Gemcitabine
- Paclitaxel
- Pemetrexed
- Vinblastine
- Vinorelbine
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What drugs are used to treat SCLC?
- Carboplatin
- Cisplatin
- Etoposide
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What are the types of NSCLC?
- Non-squamous: adenocarcinoma and large cell carcinoma
- Squamous
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What are the types of SCLC?
- Oat cell
- Intermediate cell
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What are the Paraneoplastic syndromes associated with lung cancer (esp. SCLC)?
- Cushing's syndrome
- Hypercalcemia
- SIADH
- Pulmonary hypertrophic osteoarthropathy
- Eaton-Lamber myasthenic syndrome
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What are the treatment strategies for NSCLC?
- Stage I: Surgical resection +/- Adjuvant tx +/- RT
- Stage II: Surgical resection + Adjuvant tx +/- RT
- Stage III: Surgical resection + Adjuvant tx +/- RT (Unresectable = RT + Adjuvant tx)
- Stage IV: Chemotherapy (if good performance status)
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What is the adjuvant tx for Stage I-III in NSCLC?
- Cisplatin + Vinorelbine
- Cisplatin + Etoposide
- Cisplatin + Vinblastine
- Paclitaxel + Carboplatin (only for pts w/ comorbidities or unable to tolerate Cisplatin)
- Cisplatin + Gemcitabine
- Cisplatin + Docetaxel
- Cisplatin + Pemetrexed (Non-squamous only)
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What is the chemotherapy used for Stage IV NSCLC?
- Carboplatin + Paclitaxel + Bevacizumab (Non-squamous only, No CNS mets, No hemoptysis, No anticoag)
- Cisplatin + Vinorelbine + Cetuximab
- Erlotinib (Non-squamous, EGFR positive, K-RAS negative only)
- For those not candidates for Bevacizumab or Cetuximab:
- Cisplatin +:
- Pemetrexed (non-squamous only)
- Paclitaxel
- Gemcitabine
- Docetaxel
- Vinorelbine
- Carboplatin +:
- Gemcitabine
- Docetaxel
- Pemetrexed (Non-squamous only)
- Non-platinum based:
- Gemcitabine + Docetaxel
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What is the maintenance tx for NSCLC?
- Pemetrexed
- Erlotinib
- Docetaxel
- Non-squamous only
- Only if no progression during or after 4-6 cycles
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What is the second-line tx for NSCLC if maintenance tx fails?
- Docetaxel
- Pemetrexed
- Erlotinib
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What is the third-line tx for NSCLC if second-line tx fails?
- Erlotinib (stat superior to best supportive care with respect to survival)
- Best supportive care
- Clinical trial
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What are the stages of SCLC?
- Limited: good PS, female, age<70, normal LDH
- Extensive: normal LDH, single metastatic site
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What is the tx for Limited SCLC?
- Surgery + chemo +/- RT
- Etoposide + Cisplatin or Carboplatin
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What is the tx for Extensive SCLC?
- Etoposide + Cisplatin or Carboplatin
- Irinotecan + Cisplatin or Carboplatin
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What is salvage tx for SCLC if relapse <2-3 months?
- Ifosfamide
- Paclitaxel
- Docetaxel
- Gemcitabine
- Topotecan
- Irinotecan
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What is the salvage tx for SCLC if relapse >2-3 months and <6 months?
- Topotecan
- Irinotecan
- CAV (Cyclophosphamide + Doxorubicin + Vincristine)
- Gemcitabine
- Paclitaxel
- Docetaxel
- Etoposide (PO)
- Vinorelbine
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What is the salvage tx for SCLC if relapse > 6 months?
original regimen
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