Metastatic Bronchial Carcinoma Treatment Planning

Question

Accepted Answer

Patient: A 70-year-old female with diagnosed metastatic bronchial carcinoma (Stage III).

Available data: clinical summary including bronchoscopy with pleural puncture, histological study and molecular genetic testing, chest and abdomen ultrasound, skeletal scintigraphy, ECG, echocardiography, chest MRI (written reports and images).

Problem statement

Develop the correct management plan (surgery, adjuvant, or palliative therapy).

Selected format

Written second opinion

Outcome

Upon considering the clinical data provided for evaluation, a pulmonologist at a German lung cancer center redetermined the tumor description as Stage IV cancer.

Notably, in the expert’s opinion the scope of the available molecular genetic testing was insufficient, i.e., a clear differentiation between small cell and non-small cell lung carcinoma was missing, and in the case of non-small cell carcinoma further differentiation between adenocarcinoma and squamous cell carcinoma should have been made. Moreover, PD-L1 mRNA expression should have been measured to assess the efficacy of immunotherapy. Particularly in case of adenocarcinoma, molecular biomarkers are crucial for therapy planning.

The consultant also insisted on performing video-assisted thoracoscopy to treat pleural effusion and confirm or rule out pleural carcinosis, as well as to prevent pleural effusion leakage. In case if the appropriate histologic and molecular biology testing should rule out carcinomatosis, an additional MRI or PET exam should be done to measure the extent of distant metastasis. Should carcinosis be confirmed, palliative treatment based on the molecular biomarkers expression could be administered. For example, for bone metastasis local radiation might be considered as an option.

Medconsonline comment

The remote second opinion consultation was carried out to obtain recommendations on further treatment options. The expert analyses revealed insufficiency of diagnostics in view of the current tumor management standards, and suggested a concise plan of further tests necessary to develop a custom-made therapy plan.

Consulting expert

Lung Center Hemer-Hamm

Diagnostics and treatment of lung, respiratory tract and thoracic disorders

Pulmonology