Stage IIIA squamous NSCLC: complete pathological response after docetaxel and lobectomy

What happened, in summary

A 62-year-old man was referred to hospital in June 2008 with 4 months of nonproductive cough, progressive shortness of breath, abdominal enlargement, anorexia, and severe fatigue. He had an 80-pack-year smoking history. Chest imaging showed a right hilar lung mass measuring 92 by 66 mm, and bronchoscopy found an endobronchial lesion involving the upper lobar bronchus of the right lung. Biopsy confirmed poorly differentiated squamous cell carcinoma, a form of non-small cell lung cancer. Brain MRI, abdominal CT, and FDG-PET did not show disease outside the chest, but mediastinal N2 involvement made the cancer Stage IIIA. Because his kidney function was impaired, platinum-based chemotherapy was considered too risky. He instead began single-agent docetaxel, 75 mg/m2 every 3 weeks. After 4 cycles, CT showed partial response, with the tumor reduced to 65 by 41 mm. Side effects included grade 1 anemia, grade 3 neutropenia without fever, weight loss under 10%, and fatigue, but treatment continued. By January 2009, the mass had decreased to 35 by 30 mm, and his cough and shortness of breath had resolved. After 14 cycles, CT and PET showed further shrinkage to 16 by 10 mm, allowing surgery. He underwent right lobectomy with mediastinal lymph-node sampling, and pathology showed a complete response to induction chemotherapy. The treatment course was unusual because the cancer was considered inoperable at diagnosis, yet prolonged docetaxel converted him to a surgical candidate. The response also occurred without platinum chemotherapy, which had been avoided because of renal impairment. Surgery then confirmed that no viable tumor remained in the sampled tissue.