50/M Mr SK was diagnosed with advanced cancer lung (stage4) (adenocarcinoma - never smoker) and started on chemotherapy at outside hospital. After 6 weekly dose he worsened and came to Apollo for second opinion were he met Dr Manish Singhal.

He was rendered second opinion however the treating oncologist declined to follow.

He spent more time doing another biopsy as his 1st biopsy was inadequate to do complete mutation testing. His EGFR mutations testing which is very important to conduct in lung cancer especially in never smokers had failed due to technical reasons. However, his condition kept worsening.

He finally decided to take treatment with Dr Singhal.

When he came he was breathless and required oxygen support and had to be optimized.

CT Chest showed lymphangitis carcinomatosis with large lung mass /tumor on right side and pleural effusion.

Xray chest on 07.11.2020 showed fluid in the lung (Red arrow), Large opaque lung mass(blue arrow), multiple numerous small lung nodules (lymphangitis carcinomatosis – miliary shadows in both lung fields), best appreciated in red circle.

He was started on Bevacizumab + pemetrexed + carboplatin (triple drug combination) after optimizing his general condition. This protocol is tested in Point break study and Avaperl international studies.

With in 10 days his Xray was better and on day 21st just before his second cycle he was oxygen independent, walking and climbing stairs comfortably. His X ray showed miraculous improvement – effusion disappeared, lung mass almost dissolved away and lung fields were clear off miliary nodules.