Patient: Ms. H
Age: 56 years old
Current diagnosis: Multiple lung cancer metastasis
Main consultation purpose: To clarify the specific treatment plan for the next step
Video consultation doctor: American oncologist Dr David Berz M.D
Brief medical history
2017 H The lady went to the hospital for examination due to low back pain. PET-CT scan showed that the upper lobe of the right lung was occupied by soft tissue, multiple lymphadenopathy in the mediastinum and both hilums, diffuse miliary nodules in both lungs, multiple bone destruction throughout the body, consider the lungs Malignant tumors and multiple metastases throughout the body may occur. Later, he was diagnosed as lung adenocarcinoma by a biopsy of the right iliac bone. The genetic tests for EGFR, ALK, and ROS1 were negative. In the following six months, Ms. H received 3 cycles of pemetrexed single-agent chemotherapy; A-T3 chemotherapy; 89 strontium nuclide therapy. During this period, he was admitted to the hospital for anti-inflammatory treatment due to explosive chest pain, but the chest pain did not alleviate, so he changed the medication of bevacizumab and docetaxel, but had to suspend the medication due to tachycardia. So the family members, accompanied by the attending doctor, consulted the American oncologist's second opinion on diagnosis and treatment through the hospital's "Handing Good Doctors Sino-US Remote Consultation Platform".
Sino-U.S. remote consultation with good doctors of Handing--Provide "second diagnosis and treatment opinions"
The American doctors attending this video consultation are oncology and hematology from the City of Hope National Medical Center and the Bilever Hills Cancer Center Expert Dr. David Berz, MD (Dr. David Bates), he is in the immunotherapy and personalized comprehensiveness of lung cancer, melanoma, mediastinal tumor, breast cancer, pleural cancer and other malignant solid tumors and malignant hematological tumors. The field of treatment is a national medical pioneer and has led a number of cutting-edge tumor treatment research and clinical trials. During the video process, Dr. Bates and the hospital doctors further verified the patient's condition, learned about the latest progress, and discussed relevant treatment measures with the hospital doctors.
Inspection recommendations:
Dr. Bates recommends that Ms. H take further bone scans with higher sensitivity, such as 18F-NaF PET/CT bone imaging. Assess the severely damaged areas of the axial bones, especially the spine and the weight-bearing parts of the bones, to guide external beam radiation treatment. At the same time, he also recommends massively parallel sequencing (second-generation gene sequencing, NGS) and re-take tissue for genetic testing, because taking tissue from bone metastases for genetic testing is not the best choice. The
next-generation gene sequencing (NGS) project proposes to consider FoundationOne testing, because FoundationOne testing uses next-generation sequencing technology to detect genetic changes related to the occurrence of solid tumors, including 315 cancer-related genes and 28 genes commonly found in solid tumors The choice of introns. According to the test results, potential targets can be selected for corresponding treatment. In addition, tumor mutation burden is also beneficial for selecting potentially feasible immunotherapy methods.
In addition, Dr. Bates recommends the use of DAKO 22C3 antibody for PDL-1 immunohistochemical detection.
Treatment recommendations: Dr.
Bates recommends that after the bone scan results come out, evaluate the application of local external radiation according to the situation; and combine the results of genetic testing to select the corresponding targeted drugs; according to the results of PDL-1 immunohistochemistry, use appropriate Immune checkpoint inhibitor therapy, such as pembrolizumab, atezolizumab, nivolumab, etc. These three drugs are all human monoclonal antibodies, as programmed death receptor 1 (PD-1) blockers, can bind to PD-1 and relieve the inhibitory effect of PD-1 pathway on T cells, thereby helping T Lymphocytes restore activity, recognize and destroy cancer cells.
Dr. Bates also proposed that in the case of failure of bisphosphonate therapy, denosumab can be used as a support treatment for bone metastases. Denosumab is a fully human IgG2 monoclonal antibody that can bind to RANK ligand (RANKL), a soluble or transmembrane protein necessary for the formation, function and survival of osteoclasts. The approved indications of the drug are bone-related events in patients with bone metastatic solid tumors, giant osteocytoma, hypercalcemia in patients with malignant tumors, and osteoporosis with high fracture risk.
(Remarks: The relevant treatment suggestions for the Sino-US remote consultation case of Handing Good Doctors are all individual cases and are not applicable to anyone other than the patient. All clinical treatments must follow the physician's guidance.)
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