4/11/2017 1 Melody Mendenhall, RN, MSN, NP-C UCLA Hematology and Oncology Lung Cancer/Phase I Clinical Trials Team MANAGEMENT OF LUNG CANCER OBJECTIVES Identify the incidence of lung cancer in the US Identify risk factors associated with lung cancer Review Diagnostic Techniques/Staging Distinguish the different histological types of lung cancer Discuss standard treatment/novel therapy Identify nursing implications in a patient with lung cancer ANATOMY OF THE LUNGS
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
4/11/2017
1
Melody Mendenhall, RN, MSN, NP-CUCLA Hematology and Oncology
Lung Cancer/Phase I Clinical Trials Team
MANAGEMENT OF LUNG CANCER
OBJECTIVES
Identify the incidence of lung cancer in the US Identify risk factors associated with lung cancer Review Diagnostic Techniques/Staging Distinguish the different histological types of
lung cancer Discuss standard treatment/novel therapy Identify nursing implications in a patient with
lung cancer
ANATOMY OF THE LUNGS
4/11/2017
2
LYMPH NODES
Lung cancer is the most common cause of cancer death in the US and worldwide
Around 160,000 will die of lung cancer in 2016
1 in 7 smokers will die of lung cancer 1 year survival – <50% overall 5 year survival – 17% overall
BACKGROUND
`
4/11/2017
3
RISK FACTORS
• SMOKING• SECOND HAND SMOKE• OCCUPATIONAL EXPOSURE
• ASBESTOS• RADON
• PAST MEDICAL HISTORY• CELL MUTATIONS• CHRONIC LUNG DISEASE
Radiation for patients with positive surgical margins
4/11/2017
9
ADJUVANT THERAPY
ADVANCED NSCLC. STAGE III
Mediastinal LN involvement
Supraclavicularor scalene LN
Primary tumor invades local structures (heart, spine,greatvessels, etc)
STAGE III TREATMENT OPTIONS
Surgery if possible, sometimes neo-adjuvant chemotherapy is an option
Chemo/Radiation vs sequential chemotherapy and radiation
Drugs typically given with concurrent radiation are Taxol/Carboplatin (weekly) or Carboplatin/Etoposide.
4/11/2017
10
ADVANCED NSCLC. STAGE IV
M1a Pleural or pericardial effusion Tumor with pleural nodulesNodule in the contralateral lung
M1b Cancer spread outside of the chest
Chemotherapy vs. Supportive Care
4/11/2017
11
TREATMENT PARADIGMS AFTER 2004 Determination of histology at diagnosis is mandatory.
There are differences in survival between platinum based doublets.
Three drugs may be better than two, in specific populations.
Maintenance therapy is a novel strategy and an option.
Targeted therapies have become the first line standard of care for driving mutations
Immunotherapy has become a very important treatment option
P=0.03 P=0.05
4/11/2017
12
Targeted Agents
TARGETED THERAPIES
Targeting Vascular Endothelial Growth Factor(VEGF)Bevacizumab- first line (non-squamous only), Carbo/TaxolRamicirumab- second line (all histologies), docetaxel
Diagnosis (supportive care, emotional support) Treatment decision making (education) Surgery Radiation Chemotherapy Follow-up
CASE STUDY
64 year-old female, who has never smoked presents to her dermatologist for an enlarging skin nodule on her scalp. A biopsy is taken and consistent with adenocarcinoma- lung primary.
Further imaging shows multiple right lung nodules, enlarged right paratracheal and subcarinal lymph nodes
MRI of the brain is negative Molecular studies: EGFR, ALK, KRAS negative PDL1 testing = 80%
4/11/2017
21
QUESTIONS
What is her Stage? What is first line therapy for her? What are some nursing considerations for a
patient like this What is an appropriate second line therapy
CASE STUDY
75 year-old male with metastatic squamouscell carcinoma who has been on pembrolizumab for 4 months, with a good response to treatment. His labowork has been normal.
He comes to clinic for treatment and his LFTsare mildly elevated- AST 80, ALT 104, Alk Phos180, normal bilirubin
QUESTIONS
Is this cause for concern? Why or why not? What, if any, actions need to be taken? Should treatment be withheld?