Non-Driver NSCLC: Practice Considerations
Non-Driver NSCLC: Practice Considerations
- A 72-year old male presented with dyspnea, weight loss, chronic cough, fatigue, and back pain
- PMH: current non-smoker for the past 10 years with 40-year (1-pack/day) smoking history, COPD, controlled on LABA/LAMA/ICS; hyperlipidemia controlled on atorvastatin
- Chest CT scan showed a 3.5-cm nodule in the upper lobe of the left lung
- MRI of the brain revealed lesions in the left cerebellum and left frontal lobe
- 99mTc bone scan showed increased uptake in the L1 vertebra and eighth rib
- ECOG PS=1
- Pathologic diagnosis of biopsy under bronchoscopy was squamous cell carcinoma
- IHC: PD-L1 expression in 0% of cells
- Patient was started on gemcitabine/cisplatin
- Brain metastases treated with stereotactic radiotherapy
- At 6 months, patient reported worsening fatigue
- Follow up MRI scan showed no evidence of new brain metastases
- CT scan showed new lesions in the right lung and liver
- Patient was started on atezolizumab; ICS medication for COPD was discontinued
- Patient reported decreased appetite, which resolved following implementation of self-management techniques
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