42-Year-Old Non-Smoker Diagnosed with NSCLC
Samantha is a 42-year-old mother of two. She was athletic — playing basketball in college and running mini-marathons in her 30s. She ran her first full marathon just months before she was diagnosed with NSCLC.
Severe shoulder pain prompted Samantha to go to the ER. A thoracic X-ray was suggestive of a pulmonary mass, and she was referred to a pulmonologist.
A CT scan revealed a 3.6 cm mass in the right lower lobe. Two mediastinal lymph nodes were enlarged, measuring 2.1 cm and 2.6 cm.
Because the patient was young and a non-smoker, a biopsy was performed to allow for additional molecular testing. A brain MRI was ordered.
The biopsy confirmed NSCLC adenocarcinoma. The brain MRI was negative. She was deemed unresectionable and was referred to an oncologist and radiation oncologist for possible chemotherapy combined with radiation.
Results from Samantha’s molecular testing became available before treatment plans were finalized. Her tumor tested positive for the KRAS G12C mutation.
42-Year-Old Non-Smoker Diagnosed with NSCLC
Would you suggest paclitaxel/carboplatin as first-line therapy?
Would a clinical trial utilizing a KRAS G12C inhibitor be a better option?
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Thomas BartonApril 24, 2021clinical trial with KRAS G12C inhibitor
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Anonymous UserApril 18, 2021@Kumar - while I agree the standard of care is clear, my message was to develop a clinical trial to solve the question, unless the data from PACIFIC already included specific genomic information including variants.
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Michael NemunaitisMarch 19, 2021I would rec carbo taxol radiation followed by one year of durvalumab. If there were a clinical trial adding a kras inhibitor vs placebo to standard of care, then I would consider that. Would not rec kras inhibitor now.
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Cleopatra FerraoMarch 17, 2021I do recommend this treatment after doing some research on this matter as it is the first line treatment.
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Mayer GorbatyMarch 13, 2021If a clinical trial is available I would recommend referral. Otherwise weekly paclitaxel/carbo with daily RT followed by durvalumab would be SOC at this time. I would not add in sotorasib off of protocol.
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Kumar AbhishekMarch 13, 2021@ Arturo, there is no evidence to suggest Chemo-rads followed by Durvalumab would not work in KRAS mutated NSCLC. This remains the standard of care for all patients in Stage III regardless of the driver mutation. EGFR was a small subset in PACIFIC and I still would not hang my hat on that.
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Sumit SawhneyMarch 13, 2021Pt ahs stageIII disease standard of care would be chemo /xrt and followed by immunotherapy ,pt has potential for cure ,wouldnt use sotorasib outside of a clinical trial ,may be as a maintainance therapy if a clinical trial is available .pts wit kras mutation do respond to immunotherapy
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Dilawar KhanMarch 13, 2021Would recommend kras G12C inhibitor therapy
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Sherif BadawyMarch 13, 2021Paclitaxel/carboplatin as first-line therapy is a reasonable treatment strategy given the evidence and considered one of the most commonly used first line therapies in this situation. The best next steps if the patient experienced progression is to consider a clinical trial utilizing a KRAS G12C inhibitor.
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Anonymous UserMarch 13, 2021Given that this is not a curable disease, a clinical trial that is specific for this patient population (Stage III NSCLC) would be very appropriate. While I agree chemotherapy and radiation followed by Durvalumab is standard, tumors driven by specific mutations may not respond as well to immunotherapy, which given her age is a major consideration. The clinical trial could be one including chemoradiation and instead of immunotherapy using a KRAS G12C inhibitor as a maintenance.
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Kumar AbhishekMarch 13, 2021This patient has a Stage III NSCLC. The standard of care for the treatment of Stage III NSCLC is carboplatin/Paclitaxel concurrent with radiation. If the disease responds to the treatment this would be followed by Durvalumab for one yr. Sotorasib would not be an appropriate therapy for her at this time since the alternative approach I mentioned has a chance of 4+ yr durable remission. Sotorasib would become an option if the disease progresses after initial treatment.