LWBK1006-18 LWW-Govindan-Review November 24, 2011 11:24
Chapter 18•Cancer of the Lung 211Answer 18.5. The answer is C.
Cisplatin, pemetrexed and carboplatin, paclitaxel, bevacizumab are pos-
sible treatment options to consider for patients with advanced NSCLC
with non-squamous histology. For patients with squamous histology, car-
boplatin and paclitaxel is a reasonable treatment regimen. The addition of
erlotinib to chemotherapy does not appear to improve survival, compared
to chemotherapy alone, in patients with advanced NSCLC.Answer 18.6. The answer is D.
Several randomized studies have demonstrated that there is no survival
advantage to continuing platinum doublet therapy beyond four to six
cycles. If patients experience significant toxicities following upfront ther-
apy, delaying further treatment till disease progression is a reasonable
option. Agents used in the second-line setting for the treatment of NSCLC
include docetaxel, erlotinib, and pemetrexed. Patients whose tumors have
an activating mutation in the EGFR–tyrosine kinase domain, have the
most durable benefit from erlotinib. Maintenance chemotherapy is an
option for patients with good PS and stable disease following front-line
chemotherapy, who do not experience significant treatment-related tox-
icities. Maintenance chemotherapy (either pemetrexed or erlotinib) has
been shown to improve overall survival in patients with NSCLC. Peme-
trexed maintenance would be an appropriate option for her.Answer 18.7. The answer is C.
PCI reduces the incidence of brain metastases in patients with both
limited-stage and extensive-stage SCLC, and improves survival in patients
with limited-stage SCLC. Patients with extensive-stage SCLC, who
respond well to initial front-line therapy also benefit from PCI. However,
PCI does not have a role in the management of patients with early-stage
NSCLC. Long-term cognitive decline is a side effect of PCI.Answer 18.8. The answer is D.
In a patient with limited-stage SCLC, the optimal treatment would com-
prise cisplatin and etoposide chemotherapy, concurrent with thoracic
radiation. If the tumor responds to chemotherapy, PCI should follow,
once primary treatment is complete.Answer 18.9. The answer is D.
Adjuvant platinum-based chemotherapy has been shown to improve sur-
vival in patients with stage II and III NSCLC who undergo surgical resec-
tion. Patients with stage I disease do not benefit from chemotherapy, and
a subset analysis of the JBR-10 study suggested that patients with tumor
size greater than 4 cm may benefit from adjuvant chemotherapy.Answer 18.10. The answer is B.
Patients with pulmonary carcinoid rarely present with the carcinoid
syndrome (2%). Approximately 30% of patients are asymptomatic at