ON10 Lung Cancer

Epidemiology​ -
Lung cancer rates ❌ worldwide​
Rates in males higher in developed vs. developing countries but decreasing due to tobacco control initiatives ​
Leading cause of ❌-related deaths in NZ (1600 per year)​
1 in 5 people diagnosed have ❌ smoked​
Lung cancer incidence and mortality 4x higher in ❌ and 3x higher in ❌ vs. non-Maori populations​

Screening​ - For ❌ risk patients.
- ❌ scanning - only intervention to influence mortality​
- X-ray and/or sputum cytology has shown ❌

Types of Lung Cancer​

1. Non-Small Cell Lung Cancer ​
❌% of lung cancers​. Origin from ❌ cells​. Includes adenocarcinomas, squamous cell carcinomas, large cell carcinomas​. Staged using ❌​. Better ❌ outcomes​.

2. Small Cell Lung Cancer ​
❌% of lung cancers . Origin from ❌ cells in bronchi. Rarely occurs in ❌​. Limited vs. Extensive staging​. Rapidly ❌ (metastases)​; poor ❌.

Staging NSCLC​
Stage 0 – ❌
Stage 1 – small tumor (<❌cm), ❌ lymph node involvement or mets​
Stage 2 – small to medium tumor (<3cm or 3-❌cm), ❌ node involvement, no metastases​
Stage 3 – medium to large tumor, more ❌ lymph node involvement, no metastases
Stage 4 – any size / lymph node involvement, ❌ of metastases

Match the stage to the estimated 5 year survival rate. (Randomised order.)
53-60%​ - Stage ❌
77-92%​ - Stage ❌
13-36%​ - Stage ❌
0-10%​ - Stage ❌

Match the Tx to the staging.

Stage 0​ - ❌​
Stage I​ - ❌
Stage II​ = ❌ ?Neoadjuvant CT
Stage III​ - Surgery, Radiation​❌
Stage IV​ - ❌ CT, monoclonal ❌, maintenance therapy, EGFR tyrosine kinase inhibitor (EGFR mutations), ALK inhibitors (ALK translocations), ROS1 inhibitors (ROS1 rearrangements), BRAFV600E and MEK inhibitors (BRAFV600E mutations), immune checkpoint inhibitor, local therapies…

Treatment – Stage II​

Adjuvant​ (post-primary tx):
- ❌ based therapy (5 year survival absolute benefit of 5.4%)​
- Combination drugs include ❌
Neoadjuvant​ (pre primary Tx)
Absolute benefit of 5 year survival of 6% across all stages. ​Largest study (most patient Stage I) showed ❌ survival benefit. Controversial.

Treatment – Stage III​

Adjuvant​ -
Modest survival benefits shown in FRE-IALT and ANITA trials​.
❌ typically regimen of choice .
❌ immunotherapy for patients with no progression after 2 or more cycles of chemoradiation therapy) - interim analysis showed progression-free survival ❌ months (durvalumab) vs. 5.6 months placebo (HR 0.52)​.

Cisplatin toxicity
- ❌ (stay hydrated)
- Dose dependent ❌
- Severe ❌, loss of appetite and taste
- Myelosuppression

Vinorelbine toxicity
- Peripheral ❌
- ❌
- Neutropenia
- ❌ (as are all vinca alkaloids)

SCLC Tx

Limited disease​ standard Tx = ❌ (21 day cycle x 4 cycles)​\
Extensive disease​ standard Tx = ❌ / Cyclophosphamide (21 day cycle x ❌ cycles)​. Can also use cisplatin / etoposide as above​.