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Lung Cancer Case Studies

Case Studies: NonDriver Metastatic Lung Large Cell Carcinoma

 Lyudmila Bazhenova, MD, shares insight on the diagnosis and management of a case of nondriver metastatic lung large cell carcinoma.

NonDriver Metastatic Lung Large Cell Carcinoma

  • A 70-year old woman presented with persistent cough and congestion lasting more than 6 months
    • She is a non-smoker; drinks alcohol 1-2 times/week
    • PMH: Crohn’s disease managed on infliximab; hypothyroidism, moderately well-managed on levothyroxine; osteoarthritis managed PRN on naproxen
    • Her physical exam and cardiac workup were normal
    • CBC; WNL
    • PS by ECOG assessment is 2
  • Chest X-Ray showed mass in the upper right lung
  • CT of the chest, abdomen, and pelvis showed a solid 6 X 8 cm. Right-sided pleural mass abutting the apical aspect of the chest wall and 2 small hepatic nodules measuring 1.5 cm and 2 cm.
  • Bronchoscopy and biopsy of the lung mass was performed; pathology was consistent with large cell carcinoma
    • Genetic testing was negative for known driver mutations
    • PD-L1 testing by IHC showed expression in 2% of cells
  • Brain MRI showed no evidence of CNS disease
  • Diagnosis; stage IV NSCLC
  • The patient was started on therapy with carboplatin and paclitaxel and bevacizumab
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