Participant Instructions: Welcome to the Molecular Oncology Tumor Board Series! This educational initiative is a collaboration between the American Society of Clinical Oncology (ASCO), College of American Pathologists (CAP), and Association for Molecular Pathology (AMP).
This month’s topic is led by Drs. Sanja Dacic (Surgical Pathologist from the University of Pittsburgh) and Balazs Halmos (Medical Oncologist from Montefiore Medical Center).
This discussion is inspired on a hypothetical, non-small cell lung cancer (NSCLC) patient case that was suggested by a Molecular Oncology Tumor Board participant. Do you have an interesting case in mind? Submit your hypothetical patient cases for consideration in an upcoming Molecular Oncology Tumor Board discussion forum.
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Please click below for supplemental resources related to the case.
JCO Podcast: A New Oncogene Target in Lung Cancer: Exon 14 Alterations in the MET Gene
Patient Case #1
Age/Sex: 67-year-old female
Ethnicity: Chinese origin
Presentation at diagnosis: 67-year-old woman with a moderate smoking history of ½ ppd for 15 years presented with episodes of cough, low-grade fever and a few lb. weight loss in May 2014.
Past medical history: Included well-controlled HTN, PPD positivity and a congenital hearing deficit.
Diagnostic Imaging/Pathology: Evaluation including a CT chest and PET/CT revealed a 4 cm mass with some bronchial obstruction and associated atelectasis of the lingular portion of the left upper lobe. Pathology showed a NSCLC with squamous differentiation. There were no concerns for nodal or more distant metastases. VATS lobectomy was performed and pathology demonstrated a 4.3 cm tumor, T2N0Mx with mixed adeno and squamous differentiation. EGFR/ALK testing was negative.
Adjuvant treatment: 4 cycles of adjuvant Carboplatin/Gemcitabine chemotherapy was delivered which was well tolerated. Carboplatin was substituted for Cisplatin given hearing deficit.
Follow up: Surveillance with every 6 monthly scans was initiated. The findings were found to be negative until May 2016.
Image May 2016
2016 Record
Presenting: In September 2016, patient presented with new left shoulder pain and progressive cough.
Images/Scans/Pathology: PET/CT revealed multiple new bony and lung lesions consistent with metastatic disease and a bone biopsy demonstrated findings compatible with recurrent NSCLC, squamous histology. PD-L1 testing demonstrated PD-L1 TPS of 1%. Several lung lesions appeared to show cavitation and an infectious etiology was raised. Further evaluation showed an elevated quantiferon assay and patient was initiated on anti-TB therapy. Expanded molecular testing was then pursued from the prior surgical pathology specimen and a MET exon 14 alteration was identified along with MDM2 and FRS2 amplification. As patient was deemed a poor candidate for chemotherapy given prior chemotherapy, exposure and ongoing infectious concerns a trial of crizotinib was offered.
Sept 2016 Image 1
Sept 2016 Image 2