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Sovan Sarang Dhar
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EP1.14 - Targeted Therapy (ID 204)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.14-38 - Prolonged Survival in a Case of NSCLC with Recurrent Brain Metastasis - A Case Report (Now Available) (ID 375)
08:00 - 18:00 | Author(s): Sovan Sarang Dhar
- Abstract
Background
Carcinoma lung remains the most common cause of cancer related deaths in men globally.Approximately 10 percent of newly diagnosed patients with advanced non-small cell lung cancer (NSCLC) have brain metastases. Presence of brain metastases is associated with very poor prognosis with decreased survival and compromised quality of life in patients even after intensive treatment with multimodal approach.Though the survival varies according to performance status and presence of other prognostic factors, the survival in non small cell lung cancer with brain metastasis has increased to some extent in last two decades(median survival ranges between 7 -12 months in various studies).Hereby we present our experience with a case of adenocarcinoma lung with brain metastasis on presentation who has received multiple lines of treatment approach and leading a happy and hearty life after 8 years(96 months) of diagnosis.
Method
Section not applicable
Result
CASE REPORT
A 45 year old nonsmoker male presented with constant headache with memory loss and on evaluation was found to have a SOL in the left temporal region with few other small lesions at other sites in brain along with right lung mass and was diagnosed as primary lung cancer with brain metastasis.CT guided biopsy of the lung mass showed adenocarcinoma lung.EGFR and ALK were non mutated.He received palliative whole brain radiotherapy followed by four cycles of chemotherapy with pemetrexed and carboplatin regimen.Received EBRT to right lung mass. Developed relapse after one year and underwent surgery.After six months,he developed recurrence at brain,for which surgical excision of the brain lesion(metastatectomy) was done followed by reirradiation to brain.Again he developed brain recurrence following which he received six cycles of Pemetrexed and Carboplatin followed by six cycles of maintenance Inj Pemetrexed.Again developed brain recurrence after one year which was surgically resected out following which he received Tab Erlotinib+ Tab Temezolamide . Recurrence of brain lesion was again encountered after four months for which he received six cycles of Inj Bevacizumab+ Nab-Paclitaxel + Carboplatin. Evaluation with whole body PET-CT scan and MRI brain showed complete metabolic response at primary site(lung) and partial response at brain. Then he received maintenance Inj Bevacizumab for six cycles. Then after one year,on recurrence in brain with surgical excision of the tumor and subsequent evaluation it was found that he had T790M mutation and hence was planned for Tab Osimertinib. He is on Tab Osimertinib since last 26 months. Recent evaluation was done two months back in form of whole body PET-CT scan and MRI brain which showed complete response at both primary(lung) site and brain.Patient is doing fine till date with a followup period of 96 months since upfront presentation with brain metastasis.
Conclusion
Treatment approach for NSCLC has seen a paradigm shift in last few years with the increased role of targeted therapies which has improved the survival.Hence biopsy and identifying the druggable targets have become of prime importance in managing lung malignancies.Metastatectomy and target oriented approach has always proven to be beneficial in oligometastatic settings.
