Locally Advanced NSCLC: A Case Review

Julie Brahmer, MD:This case is of a 59-year-old woman who quit smoking approximately 30 years ago. Her smoking history mainly included a 10—pack-year history of smoking, and she was diagnosed with stage 3 non‒small cell lung cancer, adenocarcinoma;EGFR,ALK,andROS1negative. She originally presented with hemoptysis,and she was found to have 2 large masses in her left lung, in the same lobe, as well as mediastinal adenopathy. She was then treated with concurrent chemotherapy and radiation, with paclitaxel and carboplatin, had a good response, and then went on to receive consolidation durvalumab (Imfinzi).

This is a case of a typical patient coming in with non‒small cell lung cancer. Of course, her light smoking history is not quite as typical as what we will see, but we know that we are seeing younger women present with this type of disease. With light smoking history, again, most of our patients have at least a current smoking or former smoking history. Smoking does not affect your risk for lung cancer but certainly can affect some of the side effect profiles of therapy while receiving concurrent chemotherapy and radiation, potentially increasing a risk of infection.

Transcript edited for clarity.

Case: A 59-year-old Woman With Locally Advanced NSCLC

• A 59-year-old woman presents after referral from primary care for persistent cough and bloody sputum. She denies shortness of breath, says cough began last fall and she attributes it and the sputum to allergies.
• History:
  • 10-year smoking history, ages 15 to 25
  • Postmenopausal, BMI = 26 kg/m²
  • Basal cell carcinoma on chest and face, had 3 lesions removed 2 years ago
• Evaluation and follow up testing reveal stage IIIB NSCLC:
  • Radiograph shows 2 lesions in left lung (3.1 cm and 5.5 cm)
  • Fiber optic bronchoscopy identifies NSCLC
  • Endobronchial ultrasound reveals ipsilateral mediastinal lymph node involvement
  • WHO performance status 1
  • Histology: nonsquamous
  • Biomarkers
    • EGFRnegative,BRAFnegative,ALK/ROS1negative
    • PD-L1 status: >25%
• Laboratory findings:
  • WBC, renal function, hepatic function within normal ranges
• After multidisciplinary evaluation, the patient was determined not to be a surgical candidate
• She completed a weekly carboplatin/paclitaxel doublet therapy with concomitant radiotherapy (60 Gy)
  • Achieved partial response without progression 3 weeks later
  • Began treatment with durvalumab