. Step 32 of 40
Clinical Stem 2
A patient with pulmonary nodules 1 year after curative intent resection of primary lung adenocarcinoma

Answer B
Platinum-based chemotherapy with or without Bevacizumab is recommended for patients with a good performance status. It is probably warranted given this patient's diagnosis of adenocarcinoma, even though she has advanced disease. Best supportive care might be more appropriate if her performance status was poor.
A conversation with the patient and family members is warranted to discuss (1) goals of care, (2) quality of life concerns, (3) risk-benefit of therapeutic alternatives, and (4) possible enrollment in a clinical trial.
References:
  1. Peters S, Adjei AA, Gridelli C, Reck M, Kerr K, Felip E; ESMO Guidelines Working Group. Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012 Oct;23 Suppl 7:vii56-64.
  2. Collabrx. http://therapy.collabrx.com/lung; Accessed on 11/24/12.
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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