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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the most common symptoms of non-small cell lung cancer (NSCLC).

  • Identify potential complications associated with NSCLC.

  • Design a treatment plan for patients with NSCLC.

  • Recommend potential second-line chemotherapy agents and regimens for treating refractory and metastatic NSCLC.

  • Design a pharmacotherapeutic plan for the treatment of hypercalcemia.

  • Describe appropriate treatment strategies for brain metastases in NSCLC.

  • Monitor carboplatin and paclitaxel therapy.

  • Educate patients on the anticipated side effects of carboplatin, paclitaxel, radiation, nivolumab, and erlotinib therapy.

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PATIENT PRESENTATION

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Chief Complaint

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“I have been coughing up blood.”

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HPI

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This 66-year-old woman presents to her PCP with complaints of a dry, nonproductive cough for 2.5 months, dyspnea on exertion, and hemoptysis for 1 week.

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PMH

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  • Dyslipidemia

  • HTN

  • Anemia of unknown etiology × 1 year

  • Type 2 DM

  • PPD (–)

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FH

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  • Father died of colorectal cancer at age 68.

  • Aunt died of breast cancer at age 70.

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SH

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Married, lives with son and daughter; 30 pack-year cigarette smoking history (approximately 1 ppd × 30 years); occasional ETOH use; no known recent exposure to TB

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Meds

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  • Folic acid 1 mg PO daily

  • Ferrous sulfate 325 mg PO TID

  • Simvastatin 20 mg PO daily

  • Metformin 500 mg PO BID

  • Pantoprazole 40 mg PO daily

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All

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  • Penicillin (rash)

  • Sulfa (rash)

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ROS

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(+) For pulmonary symptoms as noted in HPI; no headaches, dizziness, or blurred vision

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Physical Examination

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Gen
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Mildly overweight Caucasian woman in slight distress. ECOG performance status of 1.

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VS
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BP 169/100 mm Hg, P 90 bpm, RR 30, T 37.2°C; Wt 82 kg, Ht 5′6″

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Skin
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Patches of dry skin; no lesions

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HEENT
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PERRLA; EOMI; fundi benign; TMs intact

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Neck/Lymph Nodes
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No lymphadenopathy; neck supple

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Lungs
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Wheezing in RUL; remainder of lung fields clear

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Heart
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RRR; slight systolic murmur on left lateral side; normal S1, S2

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Abd
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Soft, nontender; no splenomegaly or hepatomegaly

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Genit/Rect
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Normal female genitalia; guaiac (–) stool

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Neuro
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A & O × 3; sensory and motor intact, 5/5 upper, 4/5 lower; CN II–XII intact; (–) Babinski

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Labs

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