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

Mark Socinski, MD: Lacking Actionable Mutations in NSCLC

Mark Socinski, MD
Published Online:Apr 28, 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 (e.g.; EGFR, ALK)?

 

In the first line setting for those patients who do not have actionable oncogenic drivers, the standard of care is chemotherapy. In advanced disease, it's really choosing the appropriate platinum-based doublet, which we base upon the histology of the patient. We kind of think of squamous options as different than non-squamous options. This gentleman with large-cell carcinoma obviously has a non-squamous option.

 

The two platforms of platinum-based doublets I would consider in this gentleman would be carboplatin with either pemetrexed or paclitaxel. There are others, but I think in practice today those are the two that rise to the top as the two first choices. The other option that we consider is do you add a drug like bevacizumab, an antiangiogenic, to this patient. Certainly he fits in the non-squamous diagnosis category, so that would be a consideration. We know that he has no brain metastases, so that's not an issue. The history tells us that he has no history of hemoptysis. He does no have any significant co-morbidities that would make me shy away from a drug like bevacizumab.

 

He is 72, so I think age is a consideration. There is no absolute age in which I would decide not to use bevacizumab, but I think the data suggests that with increasing age, you run the risk of increasing toxicity. So this gentleman, I would probably reccomend most likely carboplatin and paclitaxel plus bevacizumab. I think if there were concerns about toxicity, for instance if he had any evidence on baseline exam of neuropathy or he had a wonderful head of hair and alopecia was important to him, then I think it would be very reasonable to use carboplatin with pemetrexed plus bevacizumab. That would be based on their equivalent outcomes in the PointBreak trial.

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.