Talking Tumors: Contemplating Clinical Conundrums in Lung Cancer

January 29, 2020

Lecia V. Sequist, MD, MPH, and Zofia Piotrowska, MD, MHS, give their input on how they approach cases that are often encountered in clinic.

We recently traveled to Newton, Massachusetts, for a State of the Science Summit™ on Lung Cancer. Immunotherapy and targeted therapy have become important treatment approaches to consider in advanced non—small cell lung cancer. Although biomarkers such as PD-L1 expression and EGFR mutations have helped refine which patient populations are best suited to each approach, several questions remain. For example, should a patient with newly diagnosed stage IV lung adenocarcinoma whose PD-L1 expression is 90% receive single-agent pembrolizumab or chemoimmunotherapy? Additionally, what is the optimal treatment strategy in a patient with EGFR-mutant non—small cell lung cancer who is progressing on first-line osimertinib?

Therefore, we sat down with Lecia V. Sequist, MD, MPH, and Zofia Piotrowska, MD, MHS, both of Massachusetts General Hospital, to get their input on how they approach these cases that are often encountered in clinic.

First, we hear from Dr. Sequist, the Landry Family Associate Professor of Medicine at Harvard Medical School, and director of the Center for Innovation in Early Cancer Detection at Massachusetts General Hospital. Dr. Sequist presents a case of a 50-year-old man with a history of diabetes and peripheral vascular circulation problems. The patient presents with shortness of breath and is discovered to have a large pleural effusion on the right side of the chest. Listen on to hear the complete case presentation.

Next, Dr. Piotrowska, a medical oncologist at Massachusetts General Hospital and an instructor at Harvard Medical School, presents a case of a 66-year-old woman, a never-smoker, with a history of hypertension and mild anxiety. The patient initially presented with dyspnea on exertion and right-sided chest pain, and was discovered to have a right upper lobe lung mass, extensive pleural metastases, and a right-sided pleural effusion. Listen on to hear the complete case presentation.

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