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

Case Studies: NSCLC with Multiple Sites of Metastasis and No Driver Mutation

In this case-based interview, Mark Socinski, MD, describes the case of a patient with metastatic non-driver lung adenocarcinoma with brain and bone metastases.

NSCLC with Multiple Sites of Metastasis and No Driver Mutation

  • A 64-yr old gentleman presented with headache, impaired vision in left eye, and intermittent confusion that had begun a few weeks ago
  • He is a current non-smoker with a 30-pack-year history
  • Past medical history: hypertension diagnosed 3 years ago, well-controlled on losartan
  • His cardiac workup is negative
  • His PS by ECOG assessment is 1
  • Head computed tomography demonstrated a mass (1.0 cm) in left occipital lobe with associated edema
  • Full body CT scan revealed a left lower lobe lung mass (2.2 cm), and ipsilateral mediastinal lymphadnopathy
  • Whole body 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scan revealed increased FDG uptake in the primary left lower lobe lung mass, mediastinum, and several bony sites
  • Core biopsy of the lung mass was performed and indicated
    • A histopathological diagnosis of adenocarcinoma (staining for TTF-1 was positive)
    • Genetic testing was negative for known driver mutations
    • PD-L1 testing by IHC showed expression in 15% of cells
  • Brain MRI revealed 2 additional 8 mm lesions in the left frontal and right temporal lobes
  • He was diagnosed with stage IV NSCLC adenocarcinoma
  • He was treated with stereotactic radiosurgery (SRS) for brain metastases
  • Two weeks following SRS
    • A follow up MRI scan showed no evidence of new brain metastases
    • CT scan showed:
      • 4 smaller nodules in the left upper lobe
      • The left lower lobe lung mass increased in size to 3.3 cm
      • Ipsilateral mediastinal lymph node swelling
  • The patient was started on therapy with carboplatin/paclitaxel and bevacizumab
Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.