Consolidation Therapy for Locally Advanced NSCLC

Case: A 59-year-old Woman With Locally Advanced NSCLC

• A 59-year-old woman presents after referral from primary care for persistent cough and bloody sputum. She denies shortness of breath, says cough began last fall and she attributes it and the sputum to allergies.
• History:
  • 10-year smoking history, ages 15 to 25
  • Postmenopausal, BMI = 26 kg/m²
  • Basal cell carcinoma on chest and face, had 3 lesions removed 2 years ago
• Evaluation and follow up testing reveal stage IIIB NSCLC:
  • Radiograph shows 2 lesions in left lung (3.1 cm and 5.5 cm)
  • Fiber optic bronchoscopy identifies NSCLC
  • Endobronchial ultrasound reveals ipsilateral mediastinal lymph node involvement
  • WHO performance status 1
  • Histology: nonsquamous
  • Biomarkers
    • EGFRnegative,BRAFnegative,ALK/ROS1negative
    • PD-L1 status: >25%
• Laboratory findings:
  • WBC, renal function, hepatic function within normal ranges
• After multidisciplinary evaluation, the patient was determined not to be a surgical candidate
• She completed a weekly carboplatin/paclitaxel doublet therapy with concomitant radiotherapy (60 Gy)
  • Achieved partial response without progression 3 weeks later
  • Began treatment with durvalumab