What maintenance strategy would you consider for a patient like this?
So assuming that the patient received three agents and two of those were pemetrexed and bevacizumab, my recommendation would be to continue both pemetrexed and bevacizumab after the initial cycles. To me, maintenance therapy is a true no-brainer. At the end of your induction, however you define it, whatever drugs you choose, you then make an assessment, did these drugs help the patient. And you could answer that yes or no using objective and subjective criteria of your own. You then can ask is this drug safe at this point. And the third question is does this drug make sense to the patient who’s receiving it, and at the end of induction, you ask those three questions, and if the answer to all those things are that it’s effective, it’s safe, and the patient feels it’s helped them and makes sense for them and where they are in their lives, those drugs should be discontinued(?). And, in the case of this patient, it would be continuing both pemetrexed and bevacizumab.
mNSCLC: Case 1
RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.
Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left pleural effusion and enlargement of the left mediastinal and hilar lymph node.
MRI of the brain was negative for intracranial metastases.
The patient underwent resection of the primary mass which showed large cell carcinoma. Pleural fluid was tapped and also positive.
His lung cancer was staged as 4. His biopsy was sent for molecular testing and showed no actionable mutations in EGFR or ALK.
His current performance status is 1.