April 18, 2017

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