New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
An 81-year-old woman with pan-wild-type metastatic adenocarcinoma of the lung receives carboplatin/pemetrexed
1:37 minutes.
TRANSCRIPTION:
DR TSAO: She was actually a former nurse. And she was found to have Stage IV disease, which is pretty standard. I mean, she had bilateral pulmonary nodules, a couple of liver mets and some adenopathy, but no brain disease. I did profile her, because I actually think we should profile the elderly patients to try to see if we can avoid systemic chemotherapy at all costs. So I generally will profile all my patients over 70, if they have adenocarcinoma for sure. DR LOVE: She was a smoker? DR TSAO: She was actually a former nurse. I suspect she had a minimal former smoking history, but she said that it was very remote. And so she was wild type for everything. We didn’t pick up anything on our 46-gene panel. So I proceeded with carboplatin/pemetrexed. And I did dose reduce the carbo to AUC 5 at first, and the pemetrexed I kept at 500. But she didn’t tolerate it well, so in our subsequent cycles I went down to AUC 5 and then 400 for the pemetrexed. DR LOVE: And what’s the follow-up? DR TSAO: So far, she’s doing well. I think she’s on cycle 5, coming up. And then my plan will be to give her maintenance therapy, if she can continue to mount a response. She’s had, I would say, a minor response, nothing dramatic, though. DR LOVE: So you’re going to do maintenance at what point? After cycle 6? DR TSAO: Yes, actually. She had some symptom benefit, and she’s tolerating it fairly well. And after the first 2 cycles there was this small amount of shrinkage, and so I went for the other 2, and it’s like a little bit less. So I thought maybe if we just continue, I could achieve a little bit better for her. |