**2.2 Prognostic communication in patients with solid tumors—Case-based discussion**

#### *2.2.1 Case #1: ALK mutated lung cancer*

Take for example, a 53-year-old female with diabetes who reported a dry non-productive cough starting in March of 2017. She was evaluated by her primary care physician and found to have a mass of her right lung. Inadequate health insurance resulted in delays and a biopsy was obtained only in August 2017 confirming poorly differentiated high-grade neuroendocrine carcinoma with metastatic disease to the lumbar spine. She received palliative radiation to the spine, then started on standard systemic chemotherapy with cisplatin and etoposide but progressed after three cycles. She was then switched

#### *Prognostic Communication in the Era of Targeted Therapy and Immunotherapy DOI: http://dx.doi.org/10.5772/intechopen.105144*

to standard second line immunotherapy in November. Restaging scans after three cycles revealed mixed response. At this point she was following the typical natural course of lung cancer, and without new effective therapy her prognosis would have been grim. However, molecular profiling of her tumor demonstrated an ALK mutation. She was transitioned to the targeted agent ceritinib, and experienced a near complete response (**Figure 1**). She has remained on therapy without adverse events and no evidence of disease to date far exceeding the prognostic predictions at the time of second line therapy.

### *2.2.2 Case #2: Metastatic non-small cell lung cancer*

Consider a 64-year-old female with adenocarcinoma of the lung with metastatic disease to the retroperitoneum and pancreatic tail who was treated on a clinical trial with induction chemotherapy of carboplatin, paclitaxel, bevacizumab and atezolizumab resulting in rapid and dramatic response; followed by Atezolizumab maintenance with continued control of disease when she developed an encephalopathy syndrome due to the atezolizumab and treatment was discontinued. Off therapy, she developed rapid onset of progressive metastatic disease to bone causing large destructive lesions of her left hemipelvis requiring orthopedic surgery to stabilize her hip. She then completed radiation therapy to the involved area and then began maintenance doses of monoimmunotherapy with nivolumab without recurrence of encephalopathy. She has remained on maintenance immunotherapy for greater than 5 years with no evidence of disease enjoying an excellent quality of life with near normal performance status.
