Improving Overall Survival In Extensive Stage Small Cell Lung Cancer

December 5, 2019

Improving Overall Survival In Extensive Stage Small Cell Lung Cancer


Case: A 73-Year-Old Female With Stage IV SCLC

Initial presentation

  • A 73-year—old woman presented with shortness of breath, productive cough, chest pain, fatigue, anorexia and an 18-lb weight loss.
  • PMH: HTN
  • SH: Elementary school teacher; 50 pack year smoking history; quit 6 years ago; married with 2 children and her first grandchild on the way.
  • PE: Dullness to percussion, decreased breath sounds, BMI 17

Clinical workup

  • Imaging:
    • Chest x-ray showed a hilar mass and a 5.4cm right lower lobe mass
    • Chest/abdomen/pelvic CT scan revealed mediastinal adenopathy, right lower lung lobe mass, suspicious liver lesions
    • PET scan showed activity in the left upper lobe mass and supraclavicular nodal areas and liver lesions
    • No metastases to brain on MRI
  • IR biopsy of liver revealed small cell lung cancer
  • Staging: T3N3M1 - IVb
  • ECOG PS 1

Treatment

  • Concurrent durvalumab with carboplatin/etoposide; has completed 4 cycles
  • Developed constipation and nausea after second cycle (constipation successfully treated with increased oral hydration and docusate; nausea treated with ondansetron)
  • Repeated chest/abdomen/pelvis CT with contrast after every 2 cycles demonstrated significant response. After 4 cycles patient started maintenance durvalumab for 6 months
  • Continued durvalumab every 4 weeks, with CT scans at 3 and 6 months