New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
A 76-year-old man with heavily treated metastatic squamous-cell NSCLC has a response to pembrolizumab longer than 15 months
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TRANSCRIPTION:
DR LANGER: Seventy-six-year-old former/remote smoker had cough, increased sputum production, ultimately diagnosed with multifocal squamous cell carcinoma in both lungs, treated initially with carbo/gem, with response. Then, at progression, carbo/paclitaxel with radiation, full dose to the larger lesion. Progressed 10 months after that. Got stereotactic radiation to selected lesions, did well for a while, then progressed once more. Got carbo/paclitaxel alone, did well for 6 months, progressed again. Got more radiation with carbo/nab paclitaxel, with a transient response and then progression. Most of the lesions were stable. Some had declined in size, but he had a huge right lower lobe lesion, about 10, 11 centimeters, brand new right superclav node. He had never been tested for next-generation or any molecular markers. So excellent performance status. So first question, would one do molecular testing on this individual, heavily pretreated with cytotoxics? What would you do therapeutically, and would you consider more radiation? DR LOVE: So what happened? DR LANGER: So his molecular testing was completely negative and, unlike Dave’s patient, did not have 43 different — had p53 and that was it. We offered him the trial for pembrolizumab, which at that time was also taking patients who were PD-L1-negative. And we found out he was PD-L1-negative. We thought we had missed our opportunity. They had enrolled the last patient, but that patient dropped out. So he literally snagged the last slot on the PD-L1-negative arm. And his response to treatment has lasted fifteen and a half months. Superclav node disappeared, the right lower lobe mass went down from about 11 centimeters to 5 to 6, cough and dyspnea went away. I can’t think of any other agent or any cytotoxic agent that would have done as well in this setting. DR LOVE: What was the time sequence of how the response evolved? DR LANGER: Certainly by the second set of scans, about 4 months in, he was a PR. DR LOVE: Any side effects, toxicity? DR LANGER: Zero. |