Small Cell Lung Cancer With Paraneoplastic Cushing Syndrome Treated With Immunochemotherapy

What happened, in summary

A 60-year-old man was diagnosed in January 2022 with small cell lung cancer after imaging found a left lower-lung mass and enlarged hilar lymph nodes. Whole-body imaging and brain MRI showed no distant spread at first, and the cancer was Stage II. He also had excessive ACTH and cortisol production caused by the cancer, leading to paraneoplastic Cushing syndrome.

He began etoposide and platinum chemotherapy with durvalumab in March 2022. The cancer partially shrank, but severe bone-marrow suppression and serious infections repeatedly delayed treatment. Heart failure caused another interruption. He later received thoracic radiation, which further reduced the lung tumor.

By October 2022, the cancer had spread to the liver and abdominal wall, making it Stage IV. He received more etoposide and durvalumab, and the abdominal-wall metastasis was surgically removed. In 2023, after further progression, he received irinotecan and platinum chemotherapy with serplulimab. This produced another partial response, but repeated myelosuppression, infections, heart problems, and later cancer progression complicated the course. Anlotinib and bevacizumab were also used when a large pleural effusion developed.

By September 2023, liver and bone disease had progressed markedly. He died on September 23, 2023, from respiratory and cardiac failure during a severe infection following myelosuppression, 20 months after his cancer diagnosis.