Treating Patients With Non–Small Cell Lung Cancer

Opinion
Video

Expert perspectives on treating patients with non–small cell lung cancer, with a focus on treatment goals and patient factors that inform clinical decision-making and sequencing considerations.

Case: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer

Initial presentation and Clinical Workup

  • Healthy 60-year-old Caucasian woman, 45 pack-year smoker, presented with a nonproductive cough
    • Physical exam revealed ECOG PS 0, BP: 120/93, HR: 74 bpm, BMI: 22
    • Pulm: lungs CTA bilaterally
    • Chest X-Ray: 5.5-cm right mass in right upper lobe
    • CT chest/abdomen: lobulated 5.5 x 5.1-cm mass in right upper lobe
    • Biopsy of Right Upper Lobe: adenocarcinoma, TTF1 (+) consistent with NSCLC
    • Labs are WNL; PET Imaging: negative for any lymph nodes or distant metastasis; Brain MRI: negative; PFTs: Normal

Treatment 

  • Mediastinoscopy with negative lymph nodes on frozen section, followed by right upper lobectomy without complications
  • Current ECOG PS remains 0
  • Histopathology reveals 5.5-cm tumor with negative margins; 0 nodes positive for malignancy (2R, 4R, 7, and 11R are all negative)
  • Patient is diagnosed with stage IIA (pT3N0M0) lung adenocarcinoma
  • Molecular testing shows EGFR exon (19del) and PD-L1 expression of 40%.
  • Post operation, the patient completes 4 cycles of adjuvant chemotherapy with cisplatin + pemetrexed. Her ECOG PS is 1.
  • Patient begins treatment with osimertinib. 20 months after initiating osimertinib, the patient reports headaches and worsening fatigue.
  • CT scans revealed 3 new liver lesions and Brain MRI visualized 1 new lesion.

This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Sandip P. Patel, MD.

Over time, treatment goals and considerations for non–small cell lung cancer have evolved along with scientific advances enabling targeted therapies and immunotherapies. Key priorities are confirming histologic diagnosis with biopsy, getting appropriate radiographic staging imaging like PET/CT and brain MRI, and obtaining molecular profiling, at minimum EGFR, ALK, and PD-L1 testing. In metastatic disease, next-generation sequencing panels assessing ROS1, RET, MET, HER2, BRAF and other alterations help guide therapy selection.

Beyond tumor factors, assessing patient factors like comorbidities, functional status, and preferences also crucially informs treatment planning. The optimal approach synthesizes tumor biology with patient goals and needs into a cohesive plan aligned with their desired outcomes. Ongoing re-evaluation of disease, patient status, and available therapies facilitates adaptation of care over time for maximal quality of life and longevity.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.

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