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|Videos|April 10, 2018

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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