Case Summary:

• 69 year male

• Non smoker / smoker?

• Cough for 3 months

• Diagnosed as metastatic adenocarcinoma lung in October 2018

• No actionable mutation

Treatment

• Pemetrexed and carboplatin was started( JMDB study) in November 2018

• Post 3 cycles of chemotherapy WB PET/CT scan in jan 2019 s/o partial metabolic response

• Pemetrexed maintenance ( PARAMOUNT STUDY)

• Post 15 cycles scan showed increase in metabolic activity in lung lesion

• RT to lung lesion was given as extrathoracic disease was minimal

• Post RT , scan in Dec 2019 (figure 2) s/o STABLE DISEASE

• Pemetrexed continued

• Post 18 cycles of Pemetrexed maintenance scan in March 2020 s/o local progression (figure 2)



Treatment continues

• Option of DOCETAXEL ( TAX 317 and 320 study) vs NIVOLUMAB (Checkmate 057)

• NIVOLUMAB 3mg/kg was started as 2nd line therapy

• Post 5 cycles (June 2020) and 10 cycles ( August 2020) scan was done s/o stable disease (figure 3)