LWBK1006-18 LWW-Govindan-Review November 24, 2011 11:24
Chapter 18•Cancer of the Lung 213combination with chemotherapy in the first-line setting and do not result
in improved response rates, progression-free survival or overall survival.Answer 18.15. The answer is A.
The frequency of EML4–ALK translocations in unselected patients is 4%,
though is as high as 22% in patients who are never smokers. Most tumors
with EML4–ALK translocations are adenocarcinomas. EGFR mutations
and ALK rearrangements are for the most part mutually exclusive. The
gold standard for diagnosing ALK-positive NSCLC is the ALK Dual Color
break-apart probe.Answer 18.16. The answer is A.
The standard of care for locally advanced unresectable NSCLC is concur-
rent definitive chemoradiation with cisplatin and etoposide. The role of
consolidation docetaxel was investigated in a phase III study conducted by
the Hoosier Oncology Group (HOG), and was not found to improve sur-
vival over concurrent chemoradiation without consolidation therapy, and
increases toxicity. The Southwest Oncology Group (SWOG) conducted
another study in which patients who completed chemoradiation and did
not experience progressive disease, were randomized to receive gefitinib
or placebo. The gefitinib arm had a shorter survival than the placebo arm.
Prophylactic cranial radiation decreases the incidence of brain metastases
in patients with stage III disease, but does not improve overall survival
in these patients. At present there is no sufficient evidence to recommend
PCI in patients with stage III disease.Answer 18.17. The answer is B.
The standard treatment for patients with extensive stage SCLC is combi-
nation chemotherapy. Historically, alkylating agent-based regimens were
used, though the standard of care has evolved into the use of a platinum
agent and etoposide. Cisplatin and irinotecan combination does not con-
fer increased response rates or survival benefit over the use of cisplatin and
etoposide, and is associated with increased rates of grade 3 or 4 diarrhea,
while cisplatin and etoposide is associated with increased myelosuppres-
sion. Carboplatin is commonly substituted for cisplatin, due to better
toxicity profile and similar efficacy. The addition of a third agent (pacli-
taxel or ifosfamide) results in increased toxicities without clear survival
benefit. Topotecan is used in patients with relapsed/refractory disease.