|Videos|May 25, 2017
Metastatic Lung Adenocarcinoma Without a Driver Mutation
Metastatic Lung Adenocarcinoma Without a Driver Mutation
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- A 70-year-old Caucasian female presented with mild dyspnea and no chest pain.
- She has also experienced recent, rapid weight loss (>10 pounds in 1.5 months) without any changes in her diet or exercise pattern.
- She gave up smoking 7 years ago (2 packs per day for 35 years).
- Her medical history is unremarkable:
- A few years ago, she was diagnosed with gastroesophageal reflux disease that was clinically and endoscopically confirmed.
- She has no history of cancer in the family.
- Her cardiac workup is negative.
- Her PS by ECOG assessment was 0.
- Chest x-ray showed a 2.5-cm lesion in her right lower lobe.
- CT scan of the chest and abdomen confirmed the presence of the lung mass in addition to numerous bilateral nodules, all about 5 to 9 mm, in the right upper and lower lobes and the left upper and lower lobes, as well as enlargement of hilar lymph nodes. In addition, 3 small nodules were seen in the liver, measuring 1 to 2 mm.
- PET/CT imaging showed 18F-FDG uptake in the lung mass, left hilar lymph nodes, and liver.
- MRI of the brain was negative for intracranial metastases.
- A core biopsy of the lung nodule was performed:
- Its morphology and molecular phenotype (TTF-1-positivity) supported a diagnosis of lung adenocarcinoma.
- Mutational testing showed absence of driver mutations (i.e., was negative forEGFR, ROS, andALK).
- PD-L1 testing showed PD-L1 expression of 35%.
- The patient was diagnosed with stage IV metastatic NSCLC.
- The patient was started on therapy with a chemotherapy doublet and bevacizumab (Avastin).
- At her next follow-up 2 months later, her CT scan showed the right lung mass to be stable, with no new lesions. She has improved symptomatically.
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