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ONCAlert | Upfront Therapy for mRCC

Case Studies

Expert physicians provide insight on managing oncology-based patient cases that highlight the use of novel agents in clinical practice.
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A Chemoimmunotherapeutic Approach to Nondriver NSCLC

A 66-Year-Old Man With NSCLC

May 2018: H&P

  • A 66-year-old man presented to primary care with complaints of persistent cough and shortness of breath with easy exertion.
    • PE: Average height, very thin (BMI = 18 kg/m2); says he has been losing weight although not dieting; mild fever (100.6 degrees); intermittent hemoptysis
    • Lab results: CrCL 75 mL/min; A1C 6.8%; WBC 15K/µL
    • PMH: HTN managed on atenolol; former smoker (30 pack-years); attributes cough to smoking but has persisted for 3 years now since he quit
  • Primary care suspected bronchitis and prescribed amoxicillin; referred to pulmonology

June 2018: Pulmonology evaluation

  • Pulmonologist evaluated patient for COPD: diminished lung function on spirometry
  • CT revealed a 3-cm mass in left lung and multiple (<2 cm) masses in right lung, pleura, and axial lymph nodes; patient referred to oncology.

July 2018: Oncology exam

  • Biopsy identified adenocarcinoma in left lung with lymph node and pleural involvement
  • Molecular testing:
    • ALK & ROS1 rearrangement, negative
    • EGFR, KRAS wild-type
    • KRAS negative
    • PD-L1 TPS: 45%
  • Additional testing: Abdominal CT, NED; Brain MRI, NED
  • Diagnosis: Stage IVA lung adenocarcinoma without molecular drivers

August 2018

  • Patient begins treatment with pemetrexed/carboplatin plus pembrolizumab 200 mg q3 wks
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