Advanced Squamous Non-Small Cell Lung Cancer: Case 2

March 2017

• A 70-year-old female presents with shortness of breath and right-sided chest pain of 3 months’ duration
• She has a 25-year (1-pack/day) smoking history
• Chest X-ray revealed a pathologic fracture of the right 4th rib and a large right-sided pleural effusion
• CT scan confirmed the presence of a 3 cm spiculated mass in the right upper lobe, moderate right pleural effusion, and multiple lytic lesions in the spine and ribs
• Core needle biopsy of the lung mass was performed
  • Pathology showed poorly differentiated lung squamous cell carcinoma, p63+ and CK5/6+ with abundant cytokeratin
  • Genetic testing was negative for known driver mutations
  • PD-L1 testing by IHC showed expression in 20% of cells
• The patient received palliative radiation therapy to the rib
• Options for systemic therapy are under discussion