Oncology Self-Study: Symptom Management and Lung Cancer

Jan 02, 2018

Test your knowledge of symptom management and lung cancer with questions from one of ASCO’s self-assessment resources, ASCO University Essentials.

ASCO University Essentials is a year-long subscription for unlimited access to over 100 online courses covering all major tumor types including lung, breast, genitourinary, gastrointestinal, hematologic cancers, and more. Also included is ASCO University’s Personalized Learning Dashboard, a self-evaluation tool with an updated 60-question assessment that helps you find content recommendations tailored to your knowledge gaps and media preferences. Get more information on the Personalized Learning Dashboard and ASCO University Essentials.

Correct answers, rationales, and suggested reading are listed at the bottom of the page.

1. Your patient is a 67-year-old man with metastatic EGFR-mutated lung adenocarcinoma who is being treated with erlotinib. He comes to you for routine follow-up complaining of weight loss and poor appetite. He is distressed because he does not enjoy eating anymore and asks for your help. You note that he has lost almost 15% of his pre-morbid weight. At this time, you estimate his prognosis to be 6 months. 

Which of the following is the best treatment for anorexia in this patient?

  1. Dexamethasone
  2. Methylphenidate
  3. Oxandrolone 
  4. Megestrol acetate

2. A 45-year-old man comes to your clinic. He recently had progression of his metastatic lung adenocarcinoma on carboplatin, paclitaxel, and bevacizumab. You order a repeat biopsy of his large peripheral lung lesion. Molecular testing is positive for an ALK gene rearrangement. His performance status is 1.

What is the most appropriate next treatment for this patient?

  1. Pemetrexed                
  2. Docetaxel 
  3. Crizotinib
  4. Erlotinib
  5. Gemcitabine

Rationales

1: D

Both dexamethasone and megestrol acetate have been well-studied in the treatment of anorexia in cancer patients. Given that this patient has a relatively long prognosis (several months), megestrol acetate is a better choice because of its better side effect profile compared to dexamethasone. In addition, some studies have shown that the orexigenic effect of corticosteroids may only last a few weeks. Dexamethasone would be an appropriate choice for patients with shorter prognosis (i.e., 6 weeks or less). Oxandrolone is a testosterone derivative and is currently an investigational agent for the treatment of anorexia. It has no proven efficacy for the treatment of cancer-related anorexia. Methylphenidate is used to treat depressed mood and vegetative symptoms in palliative patients, but it has no role as an orexigenic agent and may even cause decreased appetite.

Suggested Readings

Del Fabbro E, et al. Symptom control in palliative care – part II: cachexia/anorexia and fatigue. J Palliat Med. 2006;9:409-421.

Dy SM and Apostol CC. Evidence-based approaches to other symptoms in advanced cancer. Cancer J. 2010;16:507-513.

2: C

A patient who has progressed on first-line chemotherapy and whose tumor harbors an ALK translocation should be treated with crizotinib based on high response rates and prolongation of progression-free survival when compared to pemetrexed or docetaxel in a recent randomized phase III trial.

References

Kwak EL, Bang YJ, Camidge DR, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010;363:1693-1703. PMID: 20979469. http://www.nejm.org/doi/full/10.1056/NEJMoa1006448   

Shaw AT, Yeap BY, Solomon BJ, et al. Effect of crizotinib on overall survival in patients with advanced non-small-cell lung cancer harbouring ALK gene rearrangement: a retrospective analysis. Lancet Oncol. 2011;12:1004-1012. PMID: 21933749. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328296/

Shaw, AT et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med. 2013 Jun 20;368(25):2385-94. http://www.nejm.org/doi/full/10.1056/NEJMoa1214886

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