Caso clinico
I Sessione:
Carcinoma polmonare
Moderatori: L. Crinò, V. Minotti
F. Passiglia
(Palermo)
Case Report
Male, 55 years ECOG PS0
Former smoker (1 pack/day for 20 years) No comorbidities
Surgery (2010): Lung adenocarcinoma (pT2, pN2, M0) Adjuvant treatments: Cisplatinum - Vinorelbine x 4
followed by RT (50 Gy)
Recurrence (2013): Adenocarcinoma (EGFR/ALK WT) First-line treatment: Carboplatinum - Pemetrexed x 6 CR follow-up
CT scan evaluation (September 2014)
ECOG PS0
Symptoms: (Dyspnea G1)
Second-line treatment options (October 2014)
Docetaxel 75 mg/mq q21
(Shepherd et al, JCO 2000)
Tarceva 150 mg os/die
(Zhu et al, JCO 2008)
Clinical Trial
Second-line treatment: Anti-PDL1 MoAb
CT scan evaluation after 4 cycles
Symptoms: DyspneaG1
Toxicities: astheniaG2, dizznessG1, artrhalgiaG1, rashG1, hipothyroidism
Basal CT-scan (September 2014 ) CT-scan (December 2014 )
CT scan evaluation after 13 cycles
Symptoms: DyspneaG1
Toxicities: astheniaG1, hipothyroidism hormone replacement
CT-scan (December 2014 ) CT-scan (July 2015 )
CT scan evaluation after 21 cycles
Symptoms: DyspneaG2, CoughG1
Toxicities: astheniaG1, hipothyroidism hormone replacement
CT-scan (July 2015 ) CT-scan (February 2016 )
G1 Symptoms: dyspnea, cough
G2
G1-2 G0-1
SD SD SD (i-R) PD
Anti-PDL1 MoAb October 2014
13 22
4 8
N. cycles
Anti- PDL1 Therapy: Efficacy/Tolerability
Toxicities: asthenia, dizzness, artrhalgia, rash, hipothyroidism
February 2016
Second/Third-line treatment options (February, 2016) Docetaxel 75 mg/mq q21
Tarceva 150 mg os/die
Nintedanib 200 mg os/bid + Docetaxel 75 mg/mq q21 (EAP)
Ramucirumab 10 mg/kg + Docetaxel 75 mg/mq q21
Nivolumab 3 mg/kg q14 (EAP) Pembrolizumab 2 mg/kg q21
Second/Third-line treatment options (February, 2016)
Rebiopsy
Adenocarcinoma, EGFR, EML-ALK, ROS1: WT
Anti-PD1 MoAb: Nivolumab (Already administered)
Nintedanib 200 mg os/bid +Docetaxel 75 mg/mq q21 (EAP)
CT scan evaluation after 3 cycles
CT-scan (February 2016 ) CT-scan (May 2016 )
Symptoms: DyspneaG1
Toxicities: astheniaG2, diarrheaG2, neutropeniaG2
G1 Symptoms: Dyspnea, Cough
G2
G1 G2
PR ?
Nintedanib 200 mg BID + Docetaxel 75 mg/mq
5 N. cycles 2
Toxicities: Asthenia, Diarrhea
Nintedanib + Docetaxel: Efficacy/Tolerability
Nintedanib 200 mg BID + Docetaxel 60 mg/mq
Treatment Ongoing
Open questions???
- Which is the best second-line option/treatment sequence in EGFR/ALK/ROS1 WT adenocarcinoma?
- Are there any potential predictive biomarkers (clinical vs radiological vs molecular)?
- New treatments - New toxicities: Are we ready?
- PD to immunotherapy (Clinical vs Radiological? i-RECIST?) (Pseudo-PD vs Real-PD?)
OS: more than 30 months…!!!
