A 70-year old woman presented with persistent cough and congestion lasting more than 6 months
She is a non-smoker; drinks alcohol 1-2 times/week
PMH: Crohn’s disease managed on infliximab; hypothyroidism, moderately well-managed on levothyroxine; osteoarthritis managed PRN on naproxen
Her physical exam and cardiac workup were normal
CBC; WNL
PS by ECOG assessment is 2
Chest X-Ray showed mass in the upper right lung
CT of the chest, abdomen, and pelvis showed a solid 6 X 8 cm. Right-sided pleural mass abutting the apical aspect of the chest wall and 2 small hepatic nodules measuring 1.5 cm and 2 cm.
Bronchoscopy and biopsy of the lung mass was performed; pathology was consistent with large cell carcinoma
Genetic testing was negative for known driver mutations
PD-L1 testing by IHC showed expression in 2% of cells
Brain MRI showed no evidence of CNS disease
Diagnosis; stage IV NSCLC
The patient was started on therapy with carboplatin and paclitaxel and bevacizumab