After completing this case study, the reader should be able to:
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.
“I have been coughing up blood.”
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.
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
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
(+) For pulmonary symptoms as noted in HPI; no headaches, dizziness, or blurred vision
Mildly overweight Caucasian woman in slight distress. ECOG performance status of 1.
BP 169/100 mm Hg, P 90 bpm, RR 30, T 37.2°C; Wt 82 kg, Ht 5′6″
Patches of dry skin; no lesions
PERRLA; EOMI; fundi benign; TMs intact
No lymphadenopathy; neck supple
Wheezing in RUL; remainder of lung fields clear
RRR; slight systolic murmur on left lateral side; normal S1, S2
Soft, nontender; no splenomegaly or hepatomegaly
Normal female genitalia; guaiac (–) stool
A & O × 3; sensory and motor intact, 5/5 upper, 4/5 lower; CN II–XII intact; (–) Babinski
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