ONCAlert | 2018 ASCO Annual Meeting
Lung Cancer Case Studies

Mark Kris, MD: Choosing a Treatment in NSCLC

Mark Kris, MD
Published Online:Apr 27, 2016
RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month's duration. He is a former smoker and quit approximately 30 years ago.

mNSCLC with Mark Kris, MD and Mark Socinski, MD: Case 1



In your practice, what option do you choose?

Well, with a cancer that we’re told is not a squamous cell carcinoma, the first drug that we would recommend would be pemetrexed. It’s a very effective and safe drug. The second drug that would be recommended would be bevacizumab, so bevacizumab in combination with other chemotherapies has been shown to improve rates of response, duration of response, and survival. And, unless this patient has contraindications, and they do not, they would be candidates for bevacizumab. The third drug is somewhat more problematic.

I think the consensus would be a “platinum-based” therapy. Cisplatin is the drug of choice, though it is a tough decision whether or not cisplatin is an appropriate drug for a patient over the age of 70. In general, most patients do not have the general strength and status to have cisplatin. Most physicians would use carboplatin. I would also ask folks to consider using drugs other than carboplatin, other active drugs like albumen-bound paclitaxel or paclitaxel, docetaxel. They could also be used in combination with pemetrexed and bevacizumab, though that is a nonstandard treatment but one I think you need to think about, particularly in patients that are not candidates for cis or carboplatin.

mNSCLC: Case 1

RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.

  • Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left pleural effusion and enlargement of the left mediastinal and hilar lymph node.
  • MRI of the brain was negative for intracranial metastases.
  • The patient underwent resection of the primary mass which showed large cell carcinoma. Pleural fluid was tapped and also positive.
  • His lung cancer was staged as 4. His biopsy was sent for molecular testing and showed no actionable mutations in EGFR or ALK.
  • His current performance status is 1.
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