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Sadaf Zehra Kazmi

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-17 - An Interesting Case of Long-Term Immunotherapy Response in Metastatic NSCLC (ID 13504)

      12:00 - 13:30  |  Author(s): Sadaf Zehra Kazmi

      • Abstract


      Immunotherapy has improved survival in advanced non-small cell lung cancer but optimal duration of treatment is unknown. We present a case of metastatic squamous cell carcinoma of lung, who continued to respond, in spite of short exposure to immunotherapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 71 year old male was diagnosed with T2N2M1 squamous cell carcinoma of lung in May, 2012. CT revealed right lung mass 4 cm and left lung lesion 1 cm but no distant metastasis. PET scan revealed FDG-avid lesion in the right lung with SUV of 18.5, sub carinal lymph node and contralaetral nodule with SUV 3.4. His case was reviewed in Lung MCC and the consensus was to treat as stage 4 due to FDG avid contralateral lung nodule.

      4c3880bb027f159e801041b1021e88e8 Result

      He received 4 cycles of carboplatin and gemcitabine from May to July of 2012, with good response. He had progressive disease in October 2012 and received palliative radiation to the chest. He responded well. Further progression was observed on a PET scan to 7.2 cm hypermetabolic lesion in right lung, right hilar and sub carinal lymph nodes with persistent hypermetabolic activity in the left lung.

      Chemotherapy with taxotere was offered form July to October of 2013. CT scan revealed reduction in size of lesion to 5 cm. In July 2014 CT revealed progressive disease with 9.1 cm right lung mass. Standard of care, Erlotinib was offered from August, 2014 to June, 2015 with good response. Further progression was revealed in July,2015 to 9.3 cm with adrenal metastases. Erlotinib was discontinued.

      Immunotherapy with Nivolumab was given from September to December of 2015. CT from December,2015 revealed index lesion in the right lung 6.9 cm compared to 9.6 cm. However, the patient developed grade 3 pneumonitis requiring admission to the hospital and was teated with steroids with discontinuation of Nivolumab.The index lesion remained stable on CT in April, 2016. Subsequently he remained stable till progression was observed on CT in May, 2017 to 9.8 cm.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The immunotherapy has revolutionized the treatment of lung cancer. Nivolumab was offered to this gentleman as a 4th line of treatment. His exposure to immunotherapy was only 3 months, which achieved a durable response of 18 months. Duration of treatment required to achieve durable response might be diffrent for each patient. More studies are needed to find out the optimal exposure to immunotherapy. This might enable a huge cost saving in a publicly funded health system.