Patient Case: A 64-Year-Old Man With Metastatic Squamous Cell NSCLC

Centering discussion on a patient scenario of metastatic squamous cell NSCLC, expert oncologist Jason Porter, MD, shares his initial impressions on the case.


Jason Porter, MD: My name is Dr Jason Porter. I’m a medical thoracic oncologist and the lung cancer disease research group leader at the West Cancer Center and Research Institute in Memphis, Tennessee. Today I’m presenting a case that I recently saw in my clinic. This is a 64-year-old male, AL, who presented to his primary care physician, with a chief complaint of worsening lower back pain, also a persistent cough and shortness of breath. Since his last visit to his PCP [primary care provider] he lost about 15 lb with no change in his eating habits, so it was unintentional weight loss. His past medical history included hypertension, as well as anxiety, both of which were controlled, and hyperlipidemia. His social history included about a 38- to 40-pack-year smoking history, and he enjoyed trying beers on weekends with his fiancé. He lives with his fiancé,… and does not have any family history significant for cancer.

His primary care physician did begin the clinical work-up. On physical exam, he had expiratory wheezes with his primary care physician. His ECOG [Eastern Cooperative Oncology Group] performance status was good. Labs were drawn, and he had a normal CBC [complete blood count]. On his liver function and renal function panel, he had only mild hypercalcemia. A CT [computerized tomography] scan of his chest was performed and showed a mass in the left upper lobe that measured about 6 cm. For further imaging, an abdominal CT was performed and it showed liver metastasis. So, this was concerning for a metastatic malignancy.

He was referred to oncology for evaluation and a biopsy was performed. The CT-guided biopsy of the liver confirmed a squamous cell carcinoma consistent with the lung. The primary PET [positron emission tomography] scan did confirm metastatic disease to the liver, as well as hilar lymph nodes on the left side with no subcarinal nodes, and there weren’t any distant metastases. MRI [magnetic resonance imaging] of his brain was completed for his staging and there weren’t any intracranial metastases noted. On the molecular evaluation of his tumor, there weren’t any actionable alterations, and PD-L1 was 30%. His molecular testing was otherwise unremarkable. He was started on therapy with cemiplimab 350 mg IV [intravenously] plus paclitaxel and carboplatin, and we’ve been following him clinically, to monitor his response.

My initial impression of his case was that this is going to be a little bit hard to take care of. This is a patient with metastatic squamous cell carcinoma of lung origin, and we know historically that the prognosis for patients who have metastatic squamous cell carcinoma is not quite as good as patients who have a nonsquamous disease. In all of our clinical trials with squamous cell carcinoma, we generally see in comparison to nonsquamous that the overall survival is lower, and usually, the progression-free survival is lower. So, I felt that his prognosis was going to be a little bit guarded, in that regard, when we compare his tumor to nonsquamous cytology.

Some risk factors for squamous cell carcinoma include smoking, of course, but also air pollution. Secondhand smoke is a huge risk factor, and then also a family history of lung cancer can increase the risk of lung cancer. Other environmental exposure such as asbestos has also been implicated in the development of squamous cell carcinoma and also radon exposure. I’m in Tennessee, and close to Kentucky, and we know that this region of the country in the United States is a hotbed for radon exposure. So these are all clinical risk factors for developing squamous cell carcinoma and other non–small cell lung cancers. And this is typical of what I see in my clinical practice.

Transcript edited for clarity.

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