ESMO Preceptorship Programme

IMMUNOTHERAPY IN NSCLC

DR PARVEEN JAIN

MEDICAL ONCOLOGY

RGCIRC

Lung cancer - India – 16.11.2017

ESMO PRECEPTORSHIP PROGRAM

Presentation Mrs X, 56 years old non smoker female

with no comorbidities presented on

16.11.2015 with history of

– Headache since 1 month

– 1 episode of generalized seizure at home (1

day back)

On Examination:

– PS 1

– Chest/CVS/CNS: unremarkable

ESMO PRECEPTORSHIP PROGRAM

MRI Brain : 3 ring enhancing lesions with heterogenous enhancement

seen in Left posterior frontal region, left parietal region and left

occipital region with moderate perilesional edema and mass effect

(midline shift ~ 7.5 mm approx.)

ESMO PRECEPTORSHIP PROGRAM

MRI Brain : 3 ring enhancing lesions with heterogenous enhancement

seen in Left posterior frontal region, left parietal region and left

occipital region with moderate perilesional edema and mass effect

(midline shift ~ 7.5 mm approx.)

ESMO PRECEPTORSHIP PROGRAM

MRI Brain : 3 ring enhancing lesions with heterogenous enhancement

seen in Left posterior frontal region, left parietal region and left

occipital region with moderate perilesional edema and mass effect

(midline shift ~ 7.5 mm approx.)

ESMO PRECEPTORSHIP PROGRAM

CXR: well defined radio-dense lesion in

right mid zone and similar lesions seen in

left lower zone & Left Hilum

ESMO PRECEPTORSHIP PROGRAM

PET-CT: FDG avid

– RLL mass (2 x 1.5 x 1.7 cms) with spiculated margins

– LLL mass (2.4 x 2.6 x 2.9 cms)

– Multiple mediastinal lymph nodes

– Multiple Brain lesions

PET-CT: FDG avid– RLL mass (2 x 1.5 x 1.7 cms) with

spiculated margins

– LLL mass (2.4 x 2.6 x 2.9 cms)

– Multiple mediastinal lymph nodes

– Multiple Brain lesions

ESMO PRECEPTORSHIP PROGRAM

Presentation CT guided FNAC and biopsy from right

lung mass (18.11.15)

– FNAC positive for Malignant cells

– Biopsy: NSCLC morphologically favoring

adenocarcinoma

– IHC: TTF-1 (+), p40 (-), Synaptophysin (-)

Molecular Profiling:

– ALK by IHC: negative

– EGFR mutation analysis (ARMS-PCR): wild

type

ESMO PRECEPTORSHIP PROGRAM

TREATMENT

Received WBRT 30Gy/10# till 30.11.2015

Started on Pemetrexed and Carboplatin based

chemotherapy (9.12.15)

– Post 3 cycles of Pemetrexed/Carboplatin Partial

Response

– Post 6 cycles of Pemetrexed/Carboplatin Further

Partial Response

Maintenance Pemetrexed (3 cycles ) till

11.07.2016 progression (new SCLN,

Lung lesions increased in size and

number)

ESMO PRECEPTORSHIP PROGRAM

Anti PD-L1 (SP263): the membranous

accentuation of tumor cells

ESMO PRECEPTORSHIP PROGRAM

TREATMENT

PD-L1: 50% (SP263 kit)

2nd line : Nivolumab 3mg/kg

– Post 4 cycles partial response

– Post 8 cycles further response

– Post 12 cycles response at all sites except

increase in size of left supraclavicular

lymphnode

FNAC from Left SCLN: positive

ESMO PRECEPTORSHIP PROGRAM

ESMO PRECEPTORSHIP PROGRAM

TREATMENT

– Case was discussed in Multispeciality clinic RT to

Left supraclavicular LN given and Nivolumab

continued

– Post 16 cycles disappearance of Left

supraclavicular LN and no change in other sites of

disease

ESMO PRECEPTORSHIP PROGRAM

ESMO PRECEPTORSHIP PROGRAM

TREATMENT

– Post 20 cycles Stable disease

– Post 24 cycles stable disease

Till date completed 26 cycles of Nivolumab

& PET-CT suggestive of stable disease.

ESMO PRECEPTORSHIP PROGRAM

THANK YOU