Patient Case: 67-Year Old Female With Advanced SCLC

Federico Albrecht, MD, oncologist/hematologist at Miami Cancer Institute of Baptist Health South Florida, discusses the challenging case of a 67-year-old heavy smoker who presented with small cell lung cancer.

The patient had extensive mediastinal involvement, liver and lung metastases, and significant symptoms like cough, chest pain, and breathlessness. Despite the advanced stage, her good performance status allowed for aggressive treatment with carboplatin/etoposide chemotherapy and atezolizumab (Tecentriq).

According to Albrecht, the patient responded incredibly well and experienced complete symptom resolution within just 2 cycles of treatment. Further, the patient achieved complete cure after 4 cycles without complications.

Transcription:

0:09 | I encountered a case involving a 67-year-old, heavy smoker, [who was] still actively smoking at the time of diagnosis. The patient presented with a rapidly progressing small cell lung cancer exceeding extensive mediastinal involvement, liver metastasis, and pulmonary metastasis as confirmed by the staging PET scan. A brain MRI did not reveal any metastasis. Apart from hypercholesterolemia and hypertension, the patient had no significant other comorbidities.

0:55 | Clinically, the patient experienced dyspnea, a significant cough, chest pains, and more. Her performance status was assessed as 2 and, in our minds, and in my perspective, that it is essential to differentiate whether the patients' compromised performance status is attributed to the disease itself or to the cause of the comorbidities. To expedite the initiation of systemic therapy, a thoracic surgeon promptly inserted a port-a-cath.

1:37 | I made a decision to start this patient rapidly on carboplatin and etoposide in combination with immunotherapy, in this case, atezolizumab. Thankfully, the patient responded remarkably well and experienced a rapid alleviation of cough and shortness of breath, with a complete resolution of chest pains just after the first and the second cycles. After cycle number 1, pure oxygen saturation levels improved, shortness of breath improved, and the cough completely resolved. [The patient] was able to completely be cured through 4 cycles of chemotherapy without problems. That is a case where a patient presents with a lot of disease and there is a cure. Daily activities are being affected, but not because the patient has comorbidities. It is because of cancer. Therefore this is a type of patient that you can treat aggressively. With the addition of immunotherapy, that made a huge difference. The patient is doing well and has improved completely to a performance status of 0.