NSCLC with Multiple Sites of Metastasis and No Driver Mutation
NSCLC with Multiple Sites of Metastasis and No Driver Mutation
- A 64-yr old gentleman presented with headache, impaired vision in left eye, and intermittent confusion that had begun a few weeks ago
- He is a current non-smoker with a 30-pack-year history
- Past medical history: hypertension diagnosed 3 years ago, well-controlled on losartan
- His cardiac workup is negative
- His PS by ECOG assessment is 1
- Head computed tomography demonstrated a mass (1.0 cm) in left occipital lobe with associated edema
- Full body CT scan revealed a left lower lobe lung mass (2.2 cm), and ipsilateral mediastinal lymphadnopathy
- Whole body 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scan revealed increased FDG uptake in the primary left lower lobe lung mass, mediastinum, and several bony sites
- Core biopsy of the lung mass was performed and indicated
- A histopathological diagnosis of adenocarcinoma (staining for TTF-1 was positive)
- Genetic testing was negative for known driver mutations
- PD-L1 testing by IHC showed expression in 15% of cells
- Brain MRI revealed 2 additional 8 mm lesions in the left frontal and right temporal lobes
- He was diagnosed with stage IV NSCLC adenocarcinoma
- He was treated with stereotactic radiosurgery (SRS) for brain metastases
- Two weeks following SRS
- A follow up MRI scan showed no evidence of new brain metastases
- CT scan showed:
- 4 smaller nodules in the left upper lobe
- The left lower lobe lung mass increased in size to 3.3 cm
- Ipsilateral mediastinal lymph node swelling
- The patient was started on therapy with carboplatin/paclitaxel and bevacizumab
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