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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
Progression confined to a single
site after complete response to
immunotherapy
Dr. Ainhoa Madariaga Urrutia
Ramon y Cajal University Hospital, Madrid, Spain
Immuno-Oncology – Amsterdam – May, 2017
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
� 52 yrs old male– Personal History:
• Former smoker since 2009. (Smoking pack year: 33)• Diabetes
mellitus type II, treated with Insulin.• Profession: Economist.
– ECOG 0.
� September 2013: Cough and hemoptysis.
– CT Scan (09/2013): • Left superior node 19x12 mm + parahiliar
mass 39x33 mm, 2.5 cm from the carina. • Contact with pulmonary
principal right artery, invassion of mediastinal fat.• Paratracheal
and subcarinal adenopathies.
– PET-CT: Increased focal methabolism in ileum, SUV 10.3.
– MRI: Normal. Not evidence of disease in small bowel.
– Sarcomatoid carcinoma of the lung cT4N2Mx.• EGFR-, KRAS-,
BRAF-, ALKt-.
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
• TREATMENT:
• SEQUENTIAL CT-RT
• Carboplatin-Paclitaxel x4 � PR (24/11/13 � 17/01/14)
• Rt 66 Gy (05/02/14 �25/03/14)
• SURGERY?
• PET-CT: Suggestive of peritoneal metastases.
• Laparoscopy: + for sarcomatoid carcinoma of the lung
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
– June 2014: Second opinion in our institution.
• Clinical Trial: Anti-PDL1 vs Docetaxel.
• Baseline CT Scan
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
– June 2014: Second opinion in our institution.
• Clinical Trial: Anti-PDL1 vs Docetaxel.
• Baseline CT Scan
• ���� Anti-PDL1
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
AUGUST 2014
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
DECEMBER 2014
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
PRSlow Pg Lung
CR Abd
Anti-PDL1
June ´14 Feb ´15 Feb ´16
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
MARCH 2016FEBRUARY 2016DECEMBER 2015
MAY 2015
OCTOBER 2015
AUGUST 2015JULY 2015APRIL 2015
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
PR
Fbc
Slow Pg LungCR Abd
Anti-PDL1
June ´14 Feb ´15
CT guided
Biopsy
Navigation
Fbc
Feb ´16
Sarcomatoid
Carcinoma
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
� What would you do?
– Continue with the same treatment.
– Start a new line of Ct.
– Radiation.
– Surgery.
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
� 04/2016 Superior right lobectomy +lymphadenectomy.
– AP: Sarcomatoid carcinoma ypT2aN0.
� What would you do?– Continue in the clinical trial.
– Surveillance.
– Start a new line of Ct.
� Continues with anti-PDL1 until present with no evidenceof
disease and no toxicity.
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ESMO Preceptorship Programme
ESMO PRECEPTORSHIP PROGRAM
AFTER 48 CYCLES…
