Roundtable Roundup: Stage IIB Lung Cancer
In 2 separate live virtual events, Firas B. Badin, MD, MBA, and Sandip P. Patel, MD, review a case of a patient with non–small cell lung cancer with their respective groups and discuss the best options for therapy.
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%
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