Quiz: Know When to Use SBRT in Lung Cancer?

Do you know what available options exist for a lung cancer patient with a BRAF V600E mutation? How about the best course of action for a patient with T2N2M0 disease? Test your knowledge and take part in a series of case scenarios to see if you can pick the correct course of action for each.

Question 1

Answer

D.SBRT has achieved primary tumor control rates and overall survival comparable to lobectomy in randomized in randomized clinical trials

Only in non-randomized population-based comparisons of medically inoperable or older lung cancer patients has SBRT achieved primary tumor control rates and overall survival comparable to lobectomy; there have been no randomized comparisons so far. A combined analysis of two randomized but incomplete trials found similar cancer-specific outcomes.

Question 2

On a chest CT scan, a 54-year-old woman is found to have a right upper lobe mass. She is a heavy smoker. Further work-up with positron-emission tomography (PET)/CT confirms a standardized uptake value (SUV)-active right upper lobe mass and a right hilar node. She undergoes right upper lobectomy and pathology reveals a 5-cm adenocarcinoma, a positive hilar node, and a positive subcarinal node that was not visible on PET/CT.

Answer

C. Adjuvant chemotherapy followed by postoperative radiation therapy

A 2005 study by Bradley et al, which was published in the Journal of Clinical Oncology, showed that patients with T1–3N2 disease discovered only at surgical exploration and negative surgical margins benefit from sequential chemotherapy followed by radiation therapy.

Question 3

A patient presents to you with chronic cough. Chest x-ray shows a hilar mass. This is followed by a PET/CT scan that shows a fluorodeoxyglucose (FDG)-avid 4-cm right hilar mass, mediastinal adenopathy, and right supraclavicular adenopathy.

Answer

A.Biopsy of the right supraclavicular node

If the supraclavicular node is positive it would confirm stage IIIB (N3 disease), which would exclude surgery as a treatment option.

Question 4

A 66-year-old man with a 40 pack-year smoking history has been diagnosed with metastatic non–small-cell lung adenocarcinoma negative for EML-ALK rearrangements, with no sensitizing EGFR mutations and negative PD-L1 expression. His cancer progresses after initial treatment with pemetrexed/carboplatin. A multi-gene assay of his tumor reports a BRAF V600E mutation.

Answer

B.Dabrafenib plus trametinib

A phase II study of 150-mg twice-daily dabrafenib and 2-mg once-daily trametinib showed an objective response rate of 63% (95% CI, 49%–76%) in previously treated non–small-cell lung cancer (NSCLC) patients with a 12.6-month duration of response. The US Food and Drug Administration approved the combination for BRAF-positive metastatic NSCLC.

Question 5

Answer

D. KRAS is not an oncogenic driver but rather a passenger, so it is undruggable

RAS is definitely an oncogenic driver. It is yet undruggable due to KRAS being a difficult target as it is a small protein with no obvious pockets for a small molecule to bind to, with the exception of a single site that binds GTP.