. Step 41 of 41
Clinical Stem 1
Non-smoking female with a new right upper lobe lung mass and three PET-positive mediastinal lymph nodes

Case Conclusion
T790M mutation was positive and MET was not amplified. ERCC1 and TS levels were low. RRM1 was also low. The patient wanted to receive standard chemotherapy. She refused to be enrolled in a clinical trial. Given her tumor's low expression of ERCC1 and TS, she is more than likely to respond to a combination of platinum and Folate analogue metabolic inhibitors such as pemetrexed.

The patient was referred to a palliative care specialist. By integrating palliative care consultation, the multidisciplinary team felt the patient's overall quality of life might be improved. Studies show a benefit of integrating palliative care with oncologic care. Both chemotherapy and performance status have been shown to positively impact survival in patients with advanced NSCLC.
Literature shows that the early introduction of palliative care can prolong survival of patients with advanced stage IIIB and IV non-small cell lung cancer.
References:
  1. Olaussen et al. DNA Repair by ERCC1 in Non?Small-Cell Lung Cancer and Cisplatin-Based Adjuvant Chemotherapy. N Engl J Med. 2006;355:983-991
  2. Rosell R et al: Ribonucleotide reductase mRNA expression and survival in gemcitabine/cisplatin-treated advanced non-small-cell lung cancer patients. Clin Cancer Res 10:1318-1325, 2004.
  3. Kawaguchi T, Takada M, Kubo A, et al. Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC. J Thorac Oncol 2010;5:620-630.
  4. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-742
Each fictitious clinical case scenario is based on a conglomerate of real patient data. Cases have been modified to avoid any possibility for patient identification and to help meet educational objectives. Any resemblance to real persons, living or deceased, is purely coincidental.

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