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that may have spread. TREATMENT WITH CHEMOTHERAPY AND RADIATION CASE 94-3, QUESTION 4: M.W. begins therapy with intravenous cisplatin on day 1 combined with etoposide on days 1 to 3 given in a 21-day cycle. Four to six cycles are planned, 2221Lung Cancer Chapter 94 and she will also receive concurrent radiation.78,79 For M.W., what is the goal of therapy? What objective baseline data should be acquired prior to starting treatment? What monitoring parameters should be utilized? The goal of therapy for a patient with limited stage disease such as M.W. would be to increase overall survival and achieve a potential cure. In patients with limited stage disease, response rates of 70% to 90% are expected after a regimen such as the one M.W. is receiving, whereas response rates of 60% to 70% are expected for patients with extensive stage disease.57 If M.W. had been diagnosed with extensive stage disease, then the goals would have been to increase overall survival and for palliation. Given the c

  noticed a 20-pound weight loss within three months, although she attributed this to changes in her diet. She was not complaining of any coughing. There was no shortness of breath. The evaluation with chest radiogram demonstrated the presence of a large mass in the right parahilar region with extension to the mediastinum and significant mediastinal adenopathy with narrowing of the trachea and its displacement to the left by the mass. The follow-up PET-CT scan confirmed presence of that large mass and no other areas of abnormality within the abdomen or pelvis. Patient also had a brain MRI which showed no evidence of metastatic disease. After that, the patient had a bronchoscopic evaluation and a biopsy of the mediastinal mass. Pathology came back positive for small cell lung carcinoma histology. Having disease only limited to the chest and mediastinum, the patient was diagnosed with limited stage SCLC. Peripheral blood chemistry, LDH, and counts were normal. What features of M.W.’s dis

 EGFR-mutation–positive tumors would be expected to experience better outcomes related to both tumor response and tolerability. Soon after erlotinib was approved by the US Food and Drug Administration (FDA), investigators noticed that patients who were women, Asian, and nonsmokers tended to respond to erlotinib therapy more frequently than other populations. However, it was subsequently realized that presence of mutations in EGFR was a better predictor of response to erlotinib therapy than demographic factors and smoking status. The prevalence of EGFR mutations is between 10% and 15% for the overall population, but is 35% in white nonsmokers, and 65% for Asian nonsmokers.47 Hence, the probability that L.L., a nonsmoking white woman, has a tumor with this somatic mutation is higher than for other categories of patients such as smokers or men. Further, the observed incidence of these mutations is less than 3% for patients with squamous cell histology; therefore, it is not recommended to