MET, RET, ROS1
Patient is a 68 year old female with newly diagnosed lung adenocarcinoma, UCSF500 shows a MET exon 14 skip mutation. What targeted treatment options does this patient have?
1. Capmatinib (GEOMETRY mono-1)
2. Tepotinib (VISION)
Is NSCLC more common or SCLC more common? Which is more lethal?
NSCLC more common and SCLC is more lethal
In patients with LS-SCLC, our preferring platinum agent is which? Cisplatin or Carboplatin?
Cisplatin if tolerated
Tarlatamab was recently approved for 2nd line ES-SCLC after progression on platinum doublet. What is this drug's MOA and what are two main side effects we monitor for?
Bispecific antibody targetting DLL3 and CD3. Two main side effects are CRS and ICANS requiring inpatient monitoring for first 2 doses with dose ramp up and can receive outpatient starting with dose 3 (day 15) then every 2 weeks moving forward.
Patient is a 65 year old male with newly diagnosed lung adenocarcinoma, UCSF500 shows a RET rearrangement mutation. What targeted treatment options does this patient have?
1. Selpercatinib (LIBRETTO-431)
2. Pralsetinib (ARROW)
What are the common sites of metastases for SCLC?
brain, liver, bone, adrenal glands
Patient is a 65 year old male with newly diagnosed limited stage small cell lung cancer of the RLL. Mediastinal staging negative so patient had a lobectomy. What would be the best course of treatment for this patient with overall great performance status following an R0 resection?
Cisplatin/Etoposide x 4 cycles
Patient is a 65 year old male with 30 year smoking history with newly diagnosed ES-SCLC of the RLL with asymptomatic brain involvement. What treatment course would you take?
Chemoimmunotherapy with platinum doublet + immunotherapy
1. Carbo/etoposide/atezolizumab (IMPOWER133)
2. Carbo/etoposide/durvalumab (CASPIAN)
Patient is a 70 year old female with newly diagnosed lung adenocarcinoma, UCSF500 shows a ROS1 rearrangement mutation. What targeted treatment options does this patient have?
1. Repotrectinib (TRIDENT)
2. Entrectinib
Modalities of Treatment for SCLC?
Surgery?
Chemotherapy?
Radiation?
All of the above for LS-SCLC depending on if pathologic mediastinal staging negative (which is <5% of patients)
Chemotherapy/Radiation for ES-SCLC
Patient is a 60 year old male with newly diagnosed limited stage small cell lung cancer of the LLL. What would be the best course of treatment for this patient with overall great performance status?
Chemoradiation with Cisplatin Etoposide + radiation x 4 cycles followed by durvalumab x 2 years (ADRIATIC)
Patient is a 67 year old male with newly diagnosed ES-SCLC of the LLL with bone involvement who has received carboplatin/etoposide/atezolizumab x4 cycles and been on maintenance atezolizumab for 6 months and subsequently progressed. What treatment options do you have?
1. Repeat platinum doublet
2. Lurbinectedin
3. Tarlatamab
4. Topotecan
What are common counseling points for MET inhibitors?
2. musculoskeletal pain
3. nausea
4. fatigue
What is our standard chemotherapy modality of treatment?
Platinum agent + etoposide
What would be your ideal patient population for prophylactic cranial irradiation? Any supportive care medications necessary?
PCI indicated for patients with good response to initial therapy, PCI decreases brain metastases and increased overall survival. PCI not recommended in patients with poor PS or impaired neurocognitive functioning. Memantine recommended to decrease neurocognitive impairment following whole brain radiation therapy for brain metastases.
Patient is a 65 year old male with newly diagnosed ES-SCLC of the RLL with brain involvement who has received carboplatin/etoposide/durvalumab x4 cycles and been on maintenance durvalumab for 2 months with progression. What treatment options do you have?
1. Lurbinectedin
2. Tarlatamab
3. Topotecan
What is an off-target of RET inhibitors? What are common counseling points for these agents?
VEGF inhibition is a main counseling point (HTN, wound healing, bleeding risk, proteinuria)
Counseling points: peripheral edema, nausea, muscle/joint aches,
Can a patient have both SCLC and NSCLC? When would this occur?
NSCLC that transforms into more aggressive SCLC
Patient is a 60 year old male with newly diagnosed limited stage small cell lung cancer of the LLL. What would be the best course of treatment for this patient with poor performance status?
Chemotherapy + RT either concurrent if tolerated or sequential
Patient is a 69 year old male with NSCLC of the lung (RLL) metastatic to liver and bone with an EGFR exon 19 deletion currently on osimertinib. Recent scans show rapid progression in osseous sites with recent biopsy showing small cell transformation in the bone. Biopsy of the liver metastases still show a EGFR exon 19 deletion. What would be your thoughts on treatment?
Continue osimertinib and initiate platinum doublet (Carboplatin AUC 5 on day 1 and etoposide 100 mg/m2 on days 1-3)