PMC5674807_01
Oncology history of the patient
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Fig1
A 74-year-old female, former smoker had resected stage III lung adenocarcinoma and was treated with adjuvant concurrent chemoradiation with carboplatin and paclitaxel in 2008 (Fig. 1). The patient was then treated with pemetrexed and sorafenib on trial (NCCTG N0626 study, http://ascopubs.org/doi/abs/10.1200/jco.2011.29.15_suppl.7513) with a durable response for more than 2 years (Fig. 1). Afterwards, the patient was on observation for 2 years until she developed symptomatic progression with extensive bony metastasis in 2014 (Figs. 1, 2a). Cytotoxic chemotherapy was discontinued after 2 months due to profound toxicities which required hospitalization, despite of dose reductions (Fig. 1).   Based on this genetic profile, the patient was started on dabrafenib in April 2015 (Fig. 1). The patient was asymptomatic from her metastatic lung cancer until the 19th month into the dabrafenib therapy, when she developed productive cough and restaging scan revealed new hypermetabolic upper abdominal lymph node metastases at the gastrohepatic ligament, precaval and peripancreatic retroperitoneum (Fig. 1). The patient was discontinued from dabrafenib and started on pembrolizumab based on her positive PD-L1 staining (90%) in December 2016 (Fig. 1). As of July 2017, the patient has no signs of disease progression after only two doses of pembrolizumab (200 mg IV) 7 weeks apart without additional therapy (Fig. 1).
a PET scan of the patient before initiation of dabrafenib reveals metastatic disease to the left iliac bone, C2 and L3-4 vertebral bodies. The C2 lesion's SUV max was 7; the lesion at L3 had a SUV max of 7.1; the left acetabulum lesion's SUV max was 5.1 prior to starting dabrafenib. b After 4 months of dabrafenib therapy, near complete resolution of PET activity in the areas of bone metastases was demonstrated without any new site of disease. Upon the best response to dabrafenib achieved, the metabolic activity resolved at C2 and L3 lesions. The left acetabulum lesion only had a very small focus of residual uptake that the max SUV was not measured
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Fig2
Afterwards, the patient was on observation for 2 years until she developed symptomatic progression with extensive bony metastasis in 2014 (Figs. 1, 2a). She had excellent clinical and radiographic responses (Fig. 2b).