Does Platinum-based Chemotherapy Still Have a Role in First-line Treatment of Advanced Non–Small-Cell Lung Cancer?

Aaron Lisberg, MD; Edward Brian Garon, MD


J Clin Oncol. 2019;37(7):529-536. 

In This Article

Case Presentation

A man in his mid-60s with a 12 pack-year smoking history presented to his primary care physician for unrelenting chest pain. A chest computed tomography scan revealed a 9.4 × 7.8 cm right upper lobe mass extending to the posterior pleural surface, with an associated trace pleural effusion. Four weeks later, the patient presented to the emergency department with dyspnea, palpitations, and hypoxia. computed tomography angiogram revealed interval growth of the right upper lobe mass, now 11.4 × 9.0 cm, with an associated large right pleural effusion displacing the mediastinum into the left thorax and compressing the right heart (Figure 1A). He was admitted to the intensive care unit. A chest tube was placed, and the dominant lung mass was biopsied, revealing poorly differentiated adenocarcinoma. His programmed death-ligand 1 (PD-L1) expression level was 90% using the 22C3 antibody (Dako, Santa Clara, CA; Figure 2). A 10-gene genomic panel did not identify actionable tumor mutations. A staging positron emission tomography scan revealed hypermetabolic uptake at the site of the primary lung mass, intrathoracic nodal metastases, and widespread metastases to bone, liver, and adrenal glands. A brain magnetic resonance imaging scan was negative for intracranial metastases.

Figure 1.

Computed tomography imaging of the patient's biopsy-proven, right upper lobe, poorly differentiated lung adenocarcinoma (A) before and (B) after four cycles of carboplatin plus pemetrexed plus pembrolizumab.

Figure 2.

Pathologic images obtained from a biopsy of the patient's right upper lobe mass stained by (A) hematoxylin and eosin and (B) programmed death-ligand 1.