What happened, in summary

A 65-year-old man presented in May 2009 with two months of cough and coughing up blood. Imaging showed a mediastinal mass and pleural effusion, and cytology from both supported small cell lung cancer. His disease was classified as T4N2M1a, stage IVA and extensive-stage.

He received six cycles of irinotecan and cisplatin and achieved a complete response. Nine months later, the mediastinal mass returned. Six cycles of irinotecan and carboplatin produced a partial response, followed by 30 Gy of thoracic radiation and prophylactic cranial irradiation.

Twenty months later, he developed jaundice and itching. Imaging found a pancreatic-head mass, and biopsy confirmed metastatic small cell lung cancer. A biliary stent relieved the obstruction. Another six cycles of irinotecan and carboplatin produced a partial response, followed by a period of stable imaging.

In 2016, a left renal lesion appeared. Oral topotecan was started but stopped after one month because of gastrointestinal toxicity. He was then lost to follow-up for two years. When he returned in 2018, the perinephric mass had enlarged substantially. Biopsy again confirmed metastatic small cell lung cancer. Because his earlier disease had repeatedly responded to irinotecan-based therapy, he received another six cycles of irinotecan and carboplatin. Imaging after four cycles showed a partial response.

At his last visit in August 2019, more than 10 years after diagnosis, he was doing well under follow-up. He described chemotherapy as harsh and said he could no longer do everything he had done before cancer, but continued to value the care and surveillance that repeatedly identified relapse while he remained fit enough for further treatment.