ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Lung Cancer Case Studies

Mark Kris, MD: Lacking Actionable Mutations in NSCLC

Mark Kris, MD
Published Online:Apr 26, 2016
RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month's duration. He is a former smoker and quit approximately 30 years ago.

mNSCLC with Mark Kris, MD and Mark Socinski, MD: Case 1



What treatment options do you consider in the first-line setting for patients such as Robert, who lack actionable mutations such as EGFR, ALK?

This scenario is a fairly common one where initial testing has been done, did not reveal EGFR or ALK. I think the first question is, is the person a candidate for additional mutational testing, and, in general, it’s always a yes for that. This case happens to be a large cell cancer, but, again, even in that case, many of these large cell cancers have characteristics of squamous or adenocarcinoma, and you need to have additional pathological testing as well as additional mutational testing. The other key question is do you stop the procedure and do an additional biopsy, and, in general, I would say yes as long as the patient was fit and as long as this is something that’s agreeable with the patient. While you’re waiting for those additional mutational results to come, again, it’s a decision based on the condition of the patient.

Can they wait until those results come back, which take anywhere from two to four weeks, or do you need to start now? If you need to start now in a patient with a large cell cancer based on the data you have that day, the treatment for that patient would be chemotherapy and also the treatment specifically would be a cisplatin-based chemotherapy if the patient is fit. Now, this patient is over the age of 70 and many of those patients do not tolerate cisplatin as well, so some thought has to come in as to the regimen that’s best for these patients.

mNSCLC: Case 1

RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.

  • Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left pleural effusion and enlargement of the left mediastinal and hilar lymph node.
  • MRI of the brain was negative for intracranial metastases.
  • The patient underwent resection of the primary mass which showed large cell carcinoma. Pleural fluid was tapped and also positive.
  • His lung cancer was staged as 4. His biopsy was sent for molecular testing and showed no actionable mutations in EGFR or ALK.
  • His current performance status is 1.
Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.