Treating Lung Adenocarcinoma Alongside a Separate Esophageal Cancer

What happened, in summary

A 69-year-old man with a long smoking history presented in June 2021 with worsening difficulty swallowing. Testing found two separate cancers at the same time: squamous cell carcinoma of the esophagus and a right upper-lung adenocarcinoma. The lung tumor was PD-L1 negative, ALK negative, and no mutations were detected on lung-cancer gene testing.

Because the two cancers were separate primaries, treatment had to be coordinated across both diseases. He first received 2 cycles of albumin-bound paclitaxel and nedaplatin with the anti-PD-1 drug sintilimab. The esophageal cancer then received its own definitive chemoradiation, while the lung nodule remained stable.

In July 2022, he began oral vinorelbine directed at the pulmonary lesion. By December, imaging showed a partial response. He then received stereotactic body radiation to the lung lesion over late December 2022 and early January 2023.

By July 2024, the lung lesion remained in partial response. He was alive 36 months after the synchronous diagnoses, eating well, and had gained 9 kg. The coordinated plan kept the lung and esophageal cancer pathways distinct while using a shared induction regimen at the start.