ADVERTISEMENT
Case Presentation: Early-Stage Non-Small Cell Lung Cancer
Patient Case:
A 67-year-old female with hypertension and Type 2 diabetes mellitus was diagnosed with stage 3 non-small cell lung cancer (NSCLC) adenocarcinoma of the right lower lobe based on single station N2 disease with positive lymph node on endobronchial ultrasound (EBUS) with a PD-L1 expression of 30%. Of note, PET-CT was negative for distal disease and indeterminate for mediastinal lymph node involvement, and EGFR and ALK were wild type.
The patient was presented at the multidisciplinary tumor board and the team decided to proceed with neoadjuvant chemotherapy with 3 cycles of carboplatin and pemetrexed combined with nivolumab, an immune checkpoint inhibitor. The patient tolerated the treatment well, with manageable side effects including mild fatigue and rash and no severe adverse events. Following the completion of the neoadjuvant therapy, imaging studies showed a significant reduction in tumor size. The patient then underwent a lobectomy to remove the residual tumor and the surgical pathology report revealed a pathological complete response (pCR), indicating no viable tumor cells in the resected specimen for the previously 4 cm tumor, and 24 lymph nodes were negative for residual disease. The patient is now in surveillance, undergoing CT chest annually.
The above case shows the importance of mediastinal pathologic staging by EBUS and to not rely just on PET-CT findings. Additionally, obtaining biomarker information with EGFR/ALK/PD-L1 is key. Finally, assessment of tumor and resected lymph nodes for pathologic response is prognostic and the achievement of pCR in stage 3 has a substantial positive prognostic benefit for this patient.
