Improving Overall Survival In Extensive Stage Small Cell Lung Cancer

Case: A 73-Year-Old Female With Stage IV SCLC

Initial presentation

• A 73-year—old woman presented with shortness of breath, productive cough, chest pain, fatigue, anorexia and an 18-lb weight loss.
• PMH: HTN
• SH: Elementary school teacher; 50 pack year smoking history; quit 6 years ago; married with 2 children and her first grandchild on the way.
• PE: Dullness to percussion, decreased breath sounds, BMI 17

Clinical workup

• Imaging:
  • Chest x-ray showed a hilar mass and a 5.4cm right lower lobe mass
  • Chest/abdomen/pelvic CT scan revealed mediastinal adenopathy, right lower lung lobe mass, suspicious liver lesions
  • PET scan showed activity in the left upper lobe mass and supraclavicular nodal areas and liver lesions
  • No metastases to brain on MRI
• IR biopsy of liver revealed small cell lung cancer
• Staging: T3N3M1 - IVb
• ECOG PS 1

Treatment

• Concurrent durvalumab with carboplatin/etoposide; has completed 4 cycles
• Developed constipation and nausea after second cycle (constipation successfully treated with increased oral hydration and docusate; nausea treated with ondansetron)
• Repeated chest/abdomen/pelvis CT with contrast after every 2 cycles demonstrated significant response. After 4 cycles patient started maintenance durvalumab for 6 months
• Continued durvalumab every 4 weeks, with CT scans at 3 and 6 months