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Case Presentation: Early-Stage Non-Small Cell Lung Cancer
Patient Case:
A 53-year old female patient was referred by a surgeon for consideration of adjuvant therapy after the patient presented to her primary care physician with a nonproductive cough. She was treated with antibiotics and inhalers without resolution of her symptoms and a chest x-ray was performed which showed a mass in the right lung.
Computer tomography confirmed the presence of the mass in the lower lobe measuring 4 centimeters without hilar or mediastinal lymphadenopathy or evidence of distant metastases. Biopsy of the mass confirmed adenocarcinoma, cytokeratin 7-positive and TTF-1 positive. PET/CT showed increased uptake in the mass with an SUV of 7 with no uptake in the hilum, mediastinum, or distant sites. MRI of the brain was negative for metastases.
Patient was taken to a right lower lobectomy and she tolerated surgery well. The patient was seen 2 weeks after surgery, at which time she no longer required pain medications and denied shortness of breath. Pathology report confirmed a grade 3 adenocarcinoma with a tumor measuring 4.5 centimeters with lymphovascular invasion. At that time, 16 lymph nodes were sampled and the station 11R lymph node was positive for malignancy. Mediastinal lymph nodes were negative and margins were negative. Patient has no past medical history. She works as a teacher and she has 2 children ages 16 and 19. She is a never smoker and denies exposure to chemicals or secondhand smoking.
On exam, she had a performance status of 0. The surgical site healed well and the exam is otherwise unremarkable. Tissue molecular and PD-L1 testing was ordered which returned with a PD-L1 of 60%, EML4-ALK translocation, and p53 mutation. Patient would like to be aggressive and is open to any therapy that will increase her chance of cure so she can see her children graduate from college.
