staging and prognosis
55-year-old smoker presents with a central mass and bulky mediastinal nodes. Imaging shows the disease is limited to one hemithorax and can fit within a single radiation port. What is the SCLC functional stage?
Limited-Stage (LS)
68-year-old male with resected Stage IIIA ALK-rearranged NSCLC is recovering from surgery. What is the preferred adjuvant treatment for 2 years
Alectinib [ALINA trial]
Which phase 3 trial established durvalumab consolidation for up to 12 months as the standard of care for unresectable Stage III NSCLC?
PACIFIC trial
Which 2024 interim analysis update established 24 months of durvalumab as maintenance therapy for Limited-Stage SCLC?
ADRIATIC trial
what defines oligometastatic NSCLC in context of many trials?
3 or less sites of mets
62-year-old former asbestos worker presents with a pleural-based mass. Histology reveals malignant cells in an epithelial pattern. How does this affect his prognosis compared to other variants?
best prognosis (it is more chemosensitive than sarcomatoid or mixed types)
mx of unresectable ds:
dual checkpoint inhibitors [nivo + ipi] Checkmate 743 trial > chemo
chemo immuno [pembro + platinum agent + pemetrexed] > chemo
62-year-old patient with metastatic squamous NSCLC (PD-L1 negative, no drivers) requires first-line therapy. What is the standard?
carboplatin, pembrolizumab, and either paclitaxel or nab-paclitaxel
Which trial was the first in decades to show a survival benefit by adding atezolizumab to chemotherapy for extensive-stage SCLC?
IMpower 133
Which recent trial established a role for osimertinib in unresectable EGFR-mutated Stage III NSCLC after completion of concurrent chemoradiation?
LAURA trial
MC secondary mutation causing resistance to first generation EGFR TKIs?
T790M
66-year-old woman undergoes a lobectomy for a 2.6-cm adenocarcinoma. Final pathology shows no pleural invasion, but two of five sampled level 11R lymph nodes contain cancer. What is her pathologic stage
Stage IIB
70-year-old female with ES-SCLC progresses 2 months after completing her first-line platinum-etoposide. What is the recently approved bispecific T-cell engager (BiTE)
tarlatamab (DLL3 and CD3)
Which trial established perioperative pembrolizumab (neoadjuvant chemoimmunotherapy followed by adjuvant immunotherapy) for resectable stage II to IIIB NSCLC?
Any relation to PD-L1 status?
how long is the adjuvant tx?
KEYNOTE-671
PD-L1>1%
1 year
In the MARIPOSA trial, which combination showed superior progression-free survival (23.7 vs 16.6 months) compared to osimertinib monotherapy in first-line EGFR-mutated NSCLC?
amivantamab and lazertinib
which ALK inhibitor showed highest intracranial response rate and longest PFS in the CROWN trial?
lorlatinib
A patient is newly diagnosed with metastatic NSCLC. According to data from 2016–2018, what is the current 3-year relative survival rate for lung cancer patients in the U.S
33%
A patient with resected Stage IIB NSCLC is found to have an EGFR exon 19 deletion. what should be the management after resection?
adjuvant chemo followed by 3 years of osimertinib
Which randomized trial showed that 3 cycles of neoadjuvant nivolumab and platinum-doublet chemotherapy significantly improved the pCR rate to 24%?
CheckMate 816
Which 2024 approval established the triplet of pembrolizumab, a platinum agent, and pemetrexed as a first-line option for unresectable mesothelioma?
CCTG IND.227 (or KEYNOTE-483)
FDA approved agents for ROS-1 rearranged NSCLC?
Crizotinib, entrectinib, repotrectinib
why molecular testing be completed before starting immunotherapy in nonsquamous NSCLC?
IO has inferior efficacy and potential for excess toxicity (eg. pneumonitis) when used before or with TKIs
A 55-year-old female presents with shoulder pain and ptosis. Imaging shows a T3N0 superior sulcus (Pancoast) tumor. What is the preferred initial management strategy?
concurrent cisplatin and etoposide with radiation therapy (followed by surgery)
Which trial demonstrated that adding pembrolizumab to platinum-pemetrexed improved survival in metastatic nonsquamous NSCLC regardless of PD-L1 status?
KEYNOTE-189
preferred first-line therapy for EGFR exon 20 insertion-positive NSCLC, which trial?
amivantamab plus platinum-doublet chemotherapy- PAPILLON study
recently which drug has shown action for KRAS G12D, phase 1
which drugs are FDA approved for KRAS G12V mutation?
Setidegrasib
none