Clinical Decisions in Non-Driver NSCLC
Clinical Decisions in Non-Driver NSCLC
- A 55-year old female presented with chronic cough and 10-lb weight loss
- PMH: never smoker; no family history of cancer; no known exposure to chemicals or asbestos
- Chest x-ray showed a 5.0-cm lesion in the left lower lobe with bulky lymphadenopathy
- Chest CT scan confirmed the presence of a lung mass and enlargement of the right hilar lymph node and bilateral mediastinal lymph nodes
- EUS-guided biopsy was performed
- Pathology revealed adenocarcinoma
- Molecular testing:
- FISH: negative for ALK translocation
- NGS: negative for EGFR, ROS1, RET, BRAF, KRAS
- IHC: PD-L1 expression in 0% of cells
- PET/CT imaging showed 18F-FDG uptake in the lung mass, right hilar lymph node, mediastinum, and left adrenal gland
- MRI of the brain was normal
- ECOG PS, 0
- The patient was started on therapy with carboplatin/pemetrexed and bevacizumab
- The regimen was well tolerated
- After 6 cycles, the patient had a good response
- She was continued on bevacizumab
- After 9 months on therapy, the patient developed cough and weight loss
- Follow-up imaging revealed multiple new lesions in the left adrenal gland and new liver metastases
- Patient was started on atezolizumab, planned for 12 months
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