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Lung Cancer Case Studies

Case Studies: Treatment Considerations for Unresectable Locally Advanced NSCLC

Heather Wakelee, MD, summarizes the case of a patient who is diagnosed with stage III unresectable non–small cell lung cancer, summarizes key findings from the PACIFIC study, and discusses the appropriateness for treating the patient with durvalumab consolidation therapy after chemoradiotherapy.

Treatment Considerations for Unresectable Locally Advanced NSCLC

  • A 64-year-old man presented with shortness of breath and persistent cough of 18 months’ duration; recently, he has experienced chest pain, fatigue, and blood in his sputum. After consulting with his primary care physician, he was referred for oncology evaluation
  • Patient history includes
    • Current smoker (1/2 pack day)
    • Hypertension
    • Acute MI at age 60
  • Evaluation and follow up testing reveal
    • Non-small cell lung cancer in left lung and 2 lymph nodes (Stage IIIa)
    • WHO performance status: 1
    • Histology: adenocarcinoma
    • EFGR, BRAF, and ALK/ROS1 mutation status: wild-type
    • PD-L1 status: ≥25%
  • He underwent multidisciplinary evaluation and was not a candidate for surgery; he was treated with chemoradiotherapy:
    • Concurrent carboplatin-paclitaxel doublet chemotherapy and radiotherapy (60 Gy)
    • Achieved partial response
  • He had no disease progression 20 days after his last radiotherapy treatment, and began treatment with durvalumab
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