A CASE OF UNUSUALLY PROLONGED SURVIVAL WITH IMMUNE-THERAPY IN NON-SMALL CELL LUNG CANCER WITH BRAIN METASTASES

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Approximately 85% of lung cancer cases are non-small-cell lung cancer (NSCLC). Most patients either present with advanced disease or develop recurrence at some point during their illness, and the 5-year survival rate for all lung cancer patients is only about 15%. The prognosis of patients with advanced NSCLC is generally considered poor, with a median survival of 8–10 months and a 2-year survival of 10%–20%. CASE PRESENTATION: We present a case of a 55 year old male who presented to the hospital in March 2016 with right-sided weakness. Computed Tomography (CT) scan of the head showed bilateral enhancing para-median parenchymal masses involving the right frontal and left frontoparietal regions measuring 21 x 23 mm, and 20 mm x 17 mm, respectively. CT scan of the chest showed a right upper lobe (RUL) mass measuring 4.5 x 6.0 cm and right hilar adenopathy measuring 2.6 x 3.8 cm. CT scan of the abdomen and pelvis was negative for pathology. Biopsy of the RUL mass was consistent with adenocarcinoma negative for any targetable mutations. The patient was started on chemotherapy and received CyberKnife treatment to the two brain lesions. In December 2016, he developed a new hypermetabolic left scapular lesion with a SUV of 5.6 and received CyberKnife treatment. He was started on Pembrolizumab in April 2017 because of four new areas of disease. He had further episodes of oligometastatic disease and was switched to the anti-PD-L1 antibody Atezolizumab given intravenously every three weeks. Over the three years since diagnosis, he received radiation to the right upper lobe and mediastinum, right and left occipital lesions, left shoulder, T8 vertebral body and left axilla. Currently, he remains on Atezolizumab with his most recent PET-CT scan showing stable post-radiation changes in the right hilar and suprahilar region, persistent stable uptake in the left axilla soft tissue mass and no new areas of abnormal uptake. MRI brain showed stable changes secondary to radiation necrosis (Figure 1). DISCUSSION: Approximately 7%–10% of patients with NSCLC present with brain metastases at the time of initial diagnosis, and up to 20%–40% of patients develop brain metastases at some point during their illness. The incidence of brain metastases appears to be increasing, likely because of improvements in diagnostic imaging. CONCLUSIONS: The prognosis of patients with brain metastases is very poor and median survival of patients with untreated brain metastases is 1–3 months. The advent of immune therapy has led us into an era where we may be seeing more exceptions to the abovementioned statistics. Our case is one such example with survival of over three years on maintenance anti-PD-L1 treatment. Reference #1: Ali A, Goffin JR, Arnold A et al. Survival of patients with non-small-cell lung cancer after a diagnosis of brain metastases. Curr Oncol. 2013 Aug; 20(4): e300–e306 DISCLOSURES: No relevant relationships by Ankit Agrawal, source=Web Response No relevant relationships by Uroosa Ibrahim, source=Web Response No relevant relationships by Amina Saqib, source=Web Response