A 72-year old male presented with dyspnea, weight loss, chronic cough, fatigue, and back pain
PMH: current non-smoker for the past 10 years with 40-year (1-pack/day) smoking history, COPD, controlled on LABA/LAMA/ICS; hyperlipidemia controlled on atorvastatin
Chest CT scan showed a 3.5-cm nodule in the upper lobe of the left lung
MRI of the brain revealed lesions in the left cerebellum and left frontal lobe
99mTc bone scan showed increased uptake in the L1 vertebra and eighth rib
ECOG PS=1
Pathologic diagnosis of biopsy under bronchoscopy was squamous cell carcinoma
IHC: PD-L1 expression in 0% of cells
Patient was started on gemcitabine/cisplatin
Brain metastases treated with stereotactic radiotherapy
At 6 months, patient reported worsening fatigue
Follow up MRI scan showed no evidence of new brain metastases
CT scan showed new lesions in the right lung and liver
Patient was started on atezolizumab; ICS medication for COPD was discontinued
Patient reported decreased appetite, which resolved following implementation of self-management techniques