All of the following statements about Non Small Cell Carcinoma of Lung (NSCCL) are true, Except:
Answer is D (Gefitinib is most effective for female smokers with adenocarcinoma on histology): Gefitinib is an oral 'small molecule Tyrosine kinase Inhibitor' (that inhibit signalling EGFR) approved for the treatment of patients with NSCCL. Data to suppo the use of Gefitinib in NSCCL are however diminishing and Gefitinib is most effective in females who have never smoked with adenocarcinoma on histology. Single agent cgemotherapy is prefered for elderly patients (> 70 years) American Society of Clinical Oncology (ASCO) recommends the use of single agent chemotherapy for elderly patients (> 70 years) with a poor performance status (2003 Guidelines) It has however now been stressed (2009 Guidelines) that age alone should not be used to select chemotherapy for patients with advanced NSCLC. Physiological Age (not chronological age) and performance status should be considered when selecting the chemotherapy regimen. Chemotherapy for Advanced (Stage IV) NSCLC Young patient Good performance status (PS < 2) Double agent chemotherapy is preferred for first line therapy Platinum based combinations are preferred over non platinum based combinations Elderly patient Poor performance status (PS 2) Single Agent Chemotherapy is preferred to reduce potential toxicity from chemotherapeutic agents. Vinorelbine or docetexal are often used for single agent chemotherapy in the elderly with a poor PS. Gefitinib is most effective for females with adenocarcinoma histology who have never smoked Gefitinib is an acceptable second line agent for treatment of patients with advanced NSCLC with adequate performance status when the disease has progressed during or after first line platinum based chemotherapy. Clinical Features that correlate with responsiveness to Gefitinib (Harrison) Female Sex Never smoking status Adenocarcinoma Histology Asian Ethinicity Contralateral Mediastinal nodes are a contraindication to Surgical Resection ALB. In otherwise fit individual, direct extension of tumour into the chest wall, diaphragm, mediastinal pleura or pericardium or to within 2 cm of the main carina does not exclude surgery. Though surgically resectable, patients with N2 (ipsilateral mediastinal) nodes may require neoadjuvant or adjuvant therapy. Contraindication to surgical resection in NSCLC (Davidson) Distant metastasis (M1) Invasion of central mediastinal structures including hea, great vessels. trachea and oesophagus (T4) Malignant pleural effusion (T4) Contralateral mediastinal nodes (N3) FEV, < 0.8L Severe or unstable cardiac or other medical condition Squammous Cell Carcinoma is the most common histological subtype of Lung Cancer in Asia (Including India) Most common lung cancer worldwide is adenocarcinoma Most common lung cancer in India (Asia) is squammous cell carcinoma Most common lung cancer in women is adenocarcinoma Most common lung cancer in smokers is squammous cell carcinoma Most common lung cancer in nonsmokers is adenocarcinoma Most common lung cancer in young patients is adenocarcinoma Most common lung cancer to metastasize is small cell carcinoma
Contralateral mediastinal nodes are a contraindication to surgical resection
Single Agent Chemotherapy is preferred for patient > 70 years with advanced disease
Squammous Cell Carcinoma is the most common NSCCL amongst Asian population
Gefitinib is most effective for female smokers with adenocarcinoma on histology