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Lung Cancer Case Studies

Case Studies: Stage IIIB Unresectable NSCLC After Chemoradiotherapy

Hossein Borghaei, DO, MS, describes the case of a 72-year-old patient with stage IIIB unresectable non–small cell lung cancer and discusses the rationale for treating her with durvalumab after chemoradiotherapy.

Stage IIIB Unresectable NSCLC After Chemoradiotherapy

Case: A 72-Year-Old Female With Stage IIIB NSCLC

Initial presentation

  • A 72-year-old woman presented with a 17-lb weight loss and dyspnea
  • PMH: HTN and hyperlipidemia
  • PSH: Laparoscopic cholecystectomy
  • SH: Smoked 3 packs/day for 30 years; Quit 5 years ago
  • PE: Unremarkable

Clinical workup

  • Imaging:
    • Chest x-ray showed a left hilar mass with a middle lobe collapse
    • CT scan of the chest/abdomen/pelvis revealed a 4.9 x 5.4 cm left upper lobe mass with bilateral hilar and mediastinal lymphadenopathy
    • CT abdomen/pelvis negative for metastatic disease
    • PET/CT confirmed activity in the lung and lymph nodes
    • MRI of the brain was negative for metastatic disease
  • CT-guided biopsy of the left lung mass revealed a differentiated invasive squamous cell carcinoma
  • Molecular testing: PD-L1 20%
  • Staging: T2bN3M0—IIIB
  • ECOG PS 1

Treatment

  • Concurrent chemoradiation with weekly carboplatin-paclitaxel
  • Imaging 6 weeks after completion showed response in the lung and lymph nodes
  • Durvalumab consolidation: 4 cycles with continued tumor control on imaging
  • Developed dyspnea and cough after 8 cycles
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