A 62-Year-Old Male With Stage III Non-Small Cell Lung Cancer

February 25, 2020

A 62-Year-Old Male With Stage III Non-Small Cell Lung Cancer


Case: A 62-Year-Old Male With Stage III NSCLC

Initial presentation

  • A 62-year-old man presented with a 2-month history of cough, wheezing, and loss of appetite
  • PMH: Hypertension, medically treated
  • SH: 30 pack-year smoking history; daughter to be married in 11 months, and wants to attend the wedding
  • PE: Right lower lobe wheezing on auscultation

Clinical workup

  • Labs: WNL
  • PFT: FEV1/FVC 60%; DLCO 55%
  • Chest/abdomen/pelvic CT showed a 6.1-cm solid pulmonary lesion in the right lower lobe, right hilar and intrapulmonary lymph node involvement; no evidence of distant metastases
  • PET scan showed large focal hypermetabolic activity in the right lower lobe and small hypermetabolic activity in the surrounding area
  • Contrast‐enhanced MRI of the head showed no brain metastases
  • Bronchoscopic biopsy of the RLL mass and hilar node revealed squamous NSCLC
  • Staging: T3N1M0 — IIIA; ECOG PS 1
    • Unresectable NSCLC based on the extent and location of disease

Treatment

  • Patient was started on cisplatin 50 mg/m2on days 1,8,29 and 36; etoposide 50 mg/m2days 1-5 and 29-33; concurrent RT
  • No disease progression after chemoradiation
  • Durvalumab 10mg/kg IV q2W was started and dose was tolerated well
  • Initial follow-up at 2 months showed partial response, with shrinkage of primary and nodal lesions