Combined small cell carcinoma and large cell neuroendocrine carcinoma?

[Tmph1980]

Hi there. My mom had an EBUS last Friday after her voice went hoarse and a scan showed a roughly 2 cm nodule on her upper right lung with some enlarged lymph nodes. The pathology came back today that one (Level 4) node was positive, and her cancer was diagnosed as combined small cell carcinoma and large cell neuroendocrine carcinoma, POU2F3-positive.

I'm freaking out because everything I read is that this is rare and aggressive. She feels totally fine other than her hoarse voice. She was supposed to meet with a thoracic surgeon tomorrow, but that was canceled and she is instead meeting with the oncologist within the next few days. She is being treated at MSKCC. 

I'd love any words of advice, thoughts, stories, etc. about this type of cancer and the types of questions we should be asking. 

Thanks in advance. 

[Tom Galli]

Tmph,

Oh my, that is a difficult presentation! Your mom's combination small cell/large cell lung cancer is rare and aggressive. I don't have any personal experience with treatment for your mom's presentation.

If conventional surgery is off the table, I suggest your mom see a radiation oncologist to see if precision radiation can treat the nodule and nodes. Sometimes, precision radiation can substitute for surgery. Here is information about small cell and large cell lung cancer. Because your mom's presentation is rare, I don't have any information about the kind of systemic chemotherapy that might be prescribed.

Stay the course.

Tom

[Tmph1980]

I'm reading the report more and doing a lot of research. It appears that LCNEC and SCLC have a lot of overlap when they're diagnosing; looking at what genes are expressed, it looks like she is SCLC-P, and there is some information on immunotherapies and drugs that people with this type of SCLC respond better to. There was an article about Zepzelca + Tecentriq published literally today that is promising, and the type of SCLC she has seems to respond to the active medicine in Zepzelca. So I feel like I have an avenue for checking this all out.