Advanced Squamous Non-Small Cell Lung Cancer: Case 1

November 2016

• An 81-year-old male presents to his physician with symptoms of cough, hemoptysis, and fatigue requiring frequent rest during the day
• PMH includes hypercholesterolemia, controlled on simvastatin and hypertension, controlled on a calcium channel blocker; mild osteoarthritis
• He has no history of smoking
• The patient is physically active and plays golf several days per week
• CT of the chest revealed a solid cystic mass in the left upper lobe and lymphadenopathy in the left hilar and bilateral mediastinal nodes
• PET/CT imaging showed 18F-FDG uptake in the lung mass, left hilar and both mediastinal lymph nodes
• Bronchoscopy and transbronchial lung biopsy were performed
• Pathology showed grade 3 squamous cell carcinoma of the lung
• Genetic testing was negative for known driver mutations
• PD-L1 testing by IHC showed expression in 65% of cells
• The patient was started on therapy with pembrolizumab
• Follow up imaging at 3 months showed stable disease

April 2017

• After 5 months on immunotherapy, the patient was hospitalized after having a seizure. He reported worsening fatigue and cough for 1 month
• CT showed increased size of the left upper lobe pulmonary mass
• Brain imaging showed several small intracranial lesions
• WBRT was started
• Immunotherapy was discontinued and the patient was started on carboplatin and nab-paclitaxel