Roundtable Roundup: Stage IIB Lung Cancer

CASE SUMMARY

History of present illness

• A 55-year-old man presented to his primary care physician with intermittent cough and dyspnea on exertion.
  

Past medical and social history

• Hyperlipidemia well managed on simvastatin
• Hypothyroidism controlled on levothyroxine
• Tobacco use: Recently quit smoking with a 25 pack-year history
  

Physical examination

• Pulmonary: Intermittent expiratory wheezing on auscultation
• Otherwise unremarkable
• ECOG performance status: 1

Laboratory profile results

• Complete blood count plus differential, chemistries, and serum creatinine: within normal limits
• Pulmonary function tests: forced expiratory volume, 1.8 L; diffusing capacity of the lungs for carbon monoxide, 35%

Imaging studies

• Chest CT: 2.8-cm spiculated right upper lobe mass; 2.1 enlarged right hilar lymph nodes measuring 2.0 cm and 1.5 cm
• PET: confirmed lung lesion and hilar lymphadenopathy without evidence of distant metastases
• Brain MRI: negative

Exploratory procedure

• Bronchoscopy with transbronchial lung biopsy of right upper lobe mass and lymph node sampling revealed adenocarcinoma at primary site with positive hilar lymph nodes
• Staging: T1cN1M0 (stage IIB)

Molecular testing

• Next-generation sequencing: no actionable mutations
• PD-L1 expression: 20%