scholarly journals Case report of three distinctive pulmonary toxicities related to durvalumab (PD-L1 inhibitor) consolidation therapy in locally advanced non-small cell lung cancer

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Andrew Gross ◽  
◽  
Asrar Alahmadi ◽  
Nikhil Ramaiya ◽  
Afshin Dowlati ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
High Dose ◽  
Small Cell Lung ◽  
Atypical Cells ◽  
The Right

Immunotherapy has become part of the standard of care in the treatment of locally advanced non-small cell lung cancer. However, immunotherapy is associated with immune-related pneumonitis and radiation-related adverse effects. Pulmonary-related toxicity after definitive chemoradiotherapy can be challenging to distinguish from disease progression, especially in the setting of additional immunotherapy after radiation. Our patient is a 61-year-old male that was diagnosed with stage IIIA lung adenocarcinoma of the right upper lobe that underwent treatment with concurrent chemoradiation and adjuvant durvalumab. He was found to have fevers, shortness of breath, generalized body aches and dry cough. His influenza test was positive for Influenza A. On imaging, there was significant hypermetabolic enlargement of multiple lymph node stations underwent bronchoscopy with biopsies of the right upper lobe, station 4R and 7 lymph node. Pathology of the right upper lobe biopsy showed fragments of bronchial epithelium with rare atypical cells present. Pathology of the station 7 lymph node showed small non-necrotizing granulomas, and station 4R showed rare atypical cells, consistent with squamous metaplasia. The patient was started on high dose prednisone for treatment of immune related pneumonitis and continue follow up in clinic. His symptoms continued to improve continued interval improvement seen on serial imaging in the right upper lobe soft tissue changes within the field of prior radiation in addition to improvement in the mediastinal and hilar lymphadenopathy, consistent with immunotherapy related Sarcoidlike granulomatous reactions.

Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients.

1998 ◽  
Vol 16 (6) ◽  
pp. 2142-2149 ◽  
Author(s):  
J F Vansteenkiste ◽  
S G Stroobants ◽  
P R De Leyn ◽  
P J Dupont ◽  
J Bogaert ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
Lymph Node Staging ◽  
Small Cell Lung ◽  
Visual Scale ◽  
Pet Ct

PURPOSE To compare the accuracy of computed tomography-(CT) scan and the radiolabeled glucose analog 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) visually correlated with CT (PET + CT) in the locoregional lymph node (LN) staging of non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Sixty-eight patients with potentially operable NSCLC underwent thoracic CT, PET, and invasive surgical staging (ISS). Imaging studies were read prospectively and blinded to the surgical and pathologic data. A five-point visual scale was used for the interpretation of LNs on PET. Afterwards, with knowledge of the pathology, the relationship between standardized uptake values (SUVs) and the presence of metastasis in LNs was explored in a receiver operating characteristic (ROC) analysis, and the likelihood ratios (LRs) for SUVs of LNs were determined. RESULTS ISS was available for 690 LN stations. CT correctly identified the nodal stage in 40 of 68 patients (59%), with understaging in 12 patients and overstaging in 16 patients. PET + CT was accurate in 59 patients (87%), with understaging in five patients and overstaging in four patients. In the detection of locally advanced disease (N2/N3), the sensitivity, specificity, and accuracy of CT were 75%, 63%, and 68%, respectively. For PET + CT, this was 93%, 95%, and 94% (P = .0004). In the ROC curve, the best SUV threshold to distinguish benign from malignant LNs was 4.40. The analysis with this SUV threshold was not superior to the use of a five-point visual scale. The LR of a SUV less than 3.5 in an LN was 0.152; for a SUV between 3.5 and 4.5, it was 3.157; and for a SUV greater than 4.5, it was 253.096. CONCLUSION PET + CT is significantly more accurate than CT alone in LN staging of NSCLC. A five-point visual scale is as accurate as the use of an SUV threshold for LNs in the distinction between benign and malignant nodes. The very high negative predictive value of mediastinal PET could reduce the need for mediastinal ISS in NSCLC substantially.

High-dose cisplatin and vinblastine infusion with or without radiation therapy in patients with advanced non-small-cell lung cancer.

1987 ◽  
Vol 5 (11) ◽  
pp. 1725-1730 ◽  
Author(s):  
M S Blumenreich ◽  
T M Woodcock ◽  
P S Gentile ◽  
G R Barnes ◽  
B Jose ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Small Cell Lung Cancer ◽  
Median Survival ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
High Dose ◽  
Small Cell Lung ◽  
To Receive

Non-small-cell lung cancer (NSCLC) patients with locally advanced or metastatic measurable disease were given a combination of cisplatin, 200 mg/m2 divided in five daily doses, and simultaneously, vinblastine, 7.5 mg/m2 as a continuous intravenous (IV) infusion over five days. Five courses of chemotherapy were planned. Afterwards or on progression, patients were randomized to receive maximally tolerated radiation to all sites of disease v observation only. Forty males and seven females were entered. Median age was 60 years (range, 37 to 74), median Karnofsky performance status was 70 (range, 30 to 90). Five patients had previous brain radiation therapy for metastatic disease, all others were previously untreated. Side effects in the 87 courses of chemotherapy administered included leukopenia (WBC less than 1,000/microL following nine courses) and thrombocytopenia (platelets less than 20,000/microL following four courses). Ten patients became septic, nine of them while leukopenic. Elevations of serum creatinine followed eight courses; in all cases the level was less than 3.0 mg/dL. Nausea and vomiting were mild to moderate. Five patients experienced mild hypoacusis and six had sensory polyneuropathy. The deaths of three patients were considered drug-related. The response rate was 28%. The median survival for the group was 22 weeks, 63.2 weeks for responders and 17.9 weeks for nonresponders. Twenty-six patients received radiation therapy, 16 randomized to this arm as planned, ten to palliate symptoms. Median survival of all irradiated patients was 24.8 weeks. Seven responders to chemotherapy were randomized to receive radiotherapy; their median survival was 25 weeks. In six responders randomized not to receive radiation, the median survival was 77.8 weeks (P greater than .3). Among nonresponding patients, the median survival of those radiated was 22.2 weeks, while that of nonradiated patients was 11 weeks. This regimen is cumbersome and toxic. It has offered no major survival benefits, or improvement in response rates, therefore, we do not recommend it for the standard treatment of NSCLC.

Trading treatment toxicity for survival in locally advanced non-small cell lung cancer.

1997 ◽  
Vol 15 (1) ◽  
pp. 330-340 ◽  
Author(s):  
M D Brundage ◽  
J R Davidson ◽  
W J Mackillop
Keyword(s):  
Prostate Cancer ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
Survival Advantage ◽  
High Dose ◽  
Small Cell Lung ◽  
Trade Off

PURPOSE To determine how patients weigh potential survival benefits against the potential toxicity of different treatment strategies for locally advanced non-small cell lung cancer (NSCLC). Specifically, we were interested in what improvement in survival probability patients would want to have before accepting more toxic therapy. PATIENTS AND METHODS Fifty-six outpatients who had experienced lung cancer (n = 22) or prostate cancer (n = 34), and 20 clinic nurses and radiation therapy technologists participated. A treatment trade-off interview was conducted with each participant that compared low-dose versus high-dose radiotherapy and high-dose radiotherapy versus combination chemo-radiotherapy. Preferences for treatments were assessed by systematically increasing the hypothetical survival advantage of the more toxic treatment until the person reached his or her threshold for choosing the more toxic treatment. RESULTS A wide range of thresholds was observed for both groups. The distributions of survival advantage thresholds for lung cancer and prostate cancer patients were not significantly different but were generally lower thresholds than those declared by staff. If the 3-year survival advantage was 10%, 60% of patients and 15% of staff would consider combination therapy over high-dose radiotherapy. Within patients, apparent willingness to consider more toxic treatments was not significantly related to age, sex, education, or preferred role in decision making. The treatment trade-off method had good test-retest reliability. CONCLUSION There is great interindividual variability in willingness to accept aggressive treatments for locally advanced NSCLC. When choosing NSCLC treatment, each patient should be provided with comprehensive information about the options so that he or she may express his or her preferences should he or she wish to participate in the decision.

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