December 18, 2020
Ticiana Leal, MD


Case: A 61-Year-Old Man With Small-Cell Lung Cancer

Initial Presentation

  • A 61-year-old man presented with a cough, fatigue, progressive shortness of breath
  • PMH: unremarkable
  • SH: 25-pack year smoking history; social alcohol use
  • PE: Right lower lobe wheezing on auscultation, axillary lymph node enlargement

Clinical Workup

  • Labs: WNL
  • Axillary lymph node biopsy revealed small cell carcinoma
  • Chest/abdomen/pelvic CT showed a 7.1 cm mediastinal conglomerate mass, with invasion into the right main and lobar pulmonary arteries; 2 small left pulmonary nodules; hypermetabolic axillary lymph node
  • PET scan showed large focal hypermetabolic activity in the mediastinum and small hypermetabolic activity in the surrounding area
  • Contrast‐enhanced MRI of the head showed no brain metastases
  • Stage IV small-cell lung cancer; ECOG PS 0

Treatment

  • Initiated carboplatin + etoposide + atezolizumab for 4 cycles; followed with atezolizumab as maintenance therapy

Follow-up

  • 7 months after starting treatment he complained of shortness of breath, right upper quadrant pain and back pain
  • CT showed hematogenous metastases in the liver and right adrenal gland
  • Initiated lurbinectedin 3.2 mg/m2 IV q21 Days