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NSCLC (Non Small Cell Lung Cancer)
- Commonly related to smoking or exposures but can see it in non-smokers (adenocarcinoma) with de-novo mutations
- Staging --> PET Scan, CT Chest, MRI Brain given potential to metastasize to CNS
- Stage IV has poor prognosis and median survival of less than 1 year
- Survival is slightly better if you have a driver mutation
Posted 01/25/17 09:20:25 AM by Ying Liu
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Driver Mutations to Check for in Lung Cancer
- EGFR
- Epidermal growth factor receptors (EGFR) are tyrosine kinases that control growth. Mutations in these receptors that cause them to be constitutively active can lead to cancer
- Mutations in EGFR are seen in 15% of NSCLC adenocarcinoma and are even more frequent in women and non-smokers
- Erlotinib in an EGFR TKI and is associated with improved PFS but not OS compared with chemotherapy
- Resistance to these EGFR TKI’s is common and can lead to progression of disease
- Toxicities include rash, diarrhea and uncommonly interstitial pneumonitis
- ALK
- Anaplastic lymphoma kinase (ALK) rearrangements result in oncogenes that encode a constitutively active kinase
- This rearrangement is seen in 4-7% of NSCLC but may be more common in non-smokers, those with adenocarcinoma and those without an EGFR mutation
- Patients are usually younger
- Crizotinib can be used as initial therapy or can be given following chemotherapy regardless of progression
- Phase III trials showed improved PFS and quality of life but no differences in OS as compared with chemotherapy
- May also have moderate activity against brain metastases
- Generally well tolerated but toxicities include GI sides effects, LFT abnormalities, pneumonitis, cardiac toxicity (bradycardia and QTc prolongation), drug interactions with CYP3A4 inhibitors, and hypersensitivity reactions
Posted 01/25/17 09:24:14 AM by Ying Liu
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For further reading...
Posted 01/25/17 09:25:06 AM by Ying Liu
Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.