Brain M- NSCLC Disclosure of interest No conflict of interest ESMO - PowerPoint PPT Presentation

ESMO Preceptorship Programme Brain Tumors– Athens,Greece– 28-29 SEP 2018 Maria Protopapa, Radiation Oncologist Aretaieio Hospital, University of Athens Brain M- NSCLC

Disclosure of interest No conflict of interest ESMO PRECEPTORSHIP PROGRAMME

Lung adenoCa T3N2M0  Date of Diagnosis: 21 SEP 2016  Demographics: male, age 63, H 178cm, W 67kg  Medical History: L open inguinal herniorrhaphy (2011)  Presentation: Pneumonia (AUG 2016)  Baseline assessment: CT lung 25 AUG 2016 RML 21mm, multistation N2 disease PET-CT 07 SEP 2016 & Second lesion RML 11mm PS 0 (ECOG), Asymptomatic  Induction CT 2c. Docetaxel-carboplatin ESMO PRECEPTORSHIP PROGRAMME

 Restaging CT lung 17 NOV 2016 PD PET-CT 23 NOV 2016 IDEM MRI brain 29 NOV 2016 NED  EGFR wt ; ALK status negative  TRT 60Gy, concurrent cisplatin 40mg/m 2 w1,w2,w3 19 DEC 2016 - 08 FEV 2017  4c Etoposide-Cisplatin 22 FEV 2017-07 APR 2107  Reassessment CT brain, thorax, abdomen 18 APR 2017 PR 29 JUN 2017 SD ESMO PRECEPTORSHIP PROGRAMME

M1b  Neurological symptoms: L pyramidal tract syndrome GR 2  MRI brain 05 OCT 2017: solitary brain M R frontal-parietal 18*16mm with edema  WBRT 10 - 23 OCT 2017 : 10 fx*300 cGy (linear accelerator 6MV) clinical improvement  2 nd line 27 NOV 2017- present : Nivolumab ESMO PRECEPTORSHIP PROGRAMME

M1b F/U 3mo after WBRT: PS 0, no steroids  No reported memory impairment MRI brain 31 JAN 2018 12*12mm PR (RANO-BM) F/U 6mo after WBRT: PS 1,  Dysphasia of expression GR 3, Muscle-weakness L-sided GR 2 Clinically improved with 15ml dexamethasone MRI brain 03 MAY 2018 16*16mm PD (RANO-BM) SD (RECIST v1.1) C Τ lung, abdomen,pelvis 31 MAY 2018 ESMO PRECEPTORSHIP PROGRAMME

M1b  SRS γ -knife 08 JUN 2018 1fx, V=8.38cm 3 20Gy to the 50% IDL Dmax 40Gy  Previous nivolumab 06 JUN 2018  Next nivolumab 20 JUN 2018  Acute toxicity None  Clinical response Muscle-weakness L-sided GR I No dysphasia Reducing steroids’ dose ESMO PRECEPTORSHIP PROGRAMME

M1b  29 JUL 2018 patient disorientated, emergency Dpt  MRI brain 25mm R frontal lobe lesion, important cerebral edema  60ml dexamethasone PS 2, dysphasia GR 2, pyramidal tract syndrome GR 3 ESMO PRECEPTORSHIP PROGRAMME

ESMO Preceptorship Programme Thank you for your attention!