Managing Metastatic NSCLC With Rapid Progression - Episode 1

Case: Advanced Squamous NSCLC With Rapid Progression

Benjamin P. Levy, MD:This patient is a 53-year-old never-smoking female who presented to her primary care physician with left shoulder pain, as well as fatigue and cough. The primary care physician treated the patient with a course of antibiotics with a presumed pneumonia diagnosis that did not improve. This led to a chest X-ray that revealed a left upper lobe opacity. This was followed by a CAT scan, which, unfortunately, revealed a 5-cm left upper lobe mass, as well as some mediastinal adenopathy. Because of the findings on the CAT scan, the patient had a core needle biopsy of the left upper lobe that, surprisingly, revealedP63-positive squamous cell lung cancer—TTF-1—negative.

The tissue was sent off for molecular testing and was negative. The PD-L1 was also sent out and was 0%. The patient subsequently went on to receive a staging workup with both a PET/CT and a brain MRI. The brain MRI was negative for any intraparenchymal metastases.

Unfortunately, the PET/CT did show a liver lesion and an adrenal lesion. Because the patient had no actionable mutation, the PD-L1 expression was less than 50%, and because the PET/CT scan revealed advanced stage disease, the patient was started on cytotoxic chemotherapy with cisplatin and gemcitabine.

Transcript edited for clarity.

Case: A 53-Year-Old Woman with mNSCLC Rapid Progression

  • A 53-year-old woman presents with a lump in her left deltoid and no other signs or symptoms
    • PMH: insignificant, currently on no medications, no smoking history
  • Chest X-ray showed a 5-cm soft tissue mass
  • Biopsy showed advanced squamous cell carcinoma, TTF-1-
    • Molecular testing negative for known actionable mutations
  • PET CT revealed a liver lesion and adrenal mass
  • Brain MRI showed no evidence of CNS metastasis
  • Staging: T2aN3M1b
  • 22C3 antibody testing; PD-L1 TPS, 0%
  • The patient is started on cisplatin/gemcitabine
  • Imaging at 3 months shows widespread progression with new and enlarging lesions including a significant increase in her soft tissue and lymph node disease, collapse of her right lower lobe and new liver lesions