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Lung Cancer Case Studies

CASE 4: 52-Year-Old Man with Relapsed Metastatic NSCLC

Published Online:Oct 11, 2016
Jonathan Riess, MD, MS, provides practical information on the use of Molecular testing in EGFR lung cancer.

EGFR Testing for Metastatic Non-Small Cell Lung Cancer with Jonathan W. Riess, MD, MS: Case 4

Jonathan W. Riess, MD, MS: Treating patients with EGFR-mutant lung cancer who have a T790M mutation, practicing in northern California, we see a lot of patients like the situation described. One in particular I could think of is a gentleman in his early 50’s who developed metastatic non–small cell lung cancer and was found to have an EGFR-activating mutation. His cancer had spread to the bone and the brain. He had radiation to the lesions in the brain and was started on erlotinib. He had a very nice response for about 12 months, and then developed progressive disease with worsening primary lung lesion and other spots in the lung. We performed a tissue biopsy and that showed an EGFR T790M mutation. He was placed on osimertinib and has done very well. So, overall, he has tolerated it well. He has had some nice shrinkage of his tumor, improvement in his cough and symptoms, and still continues on osimertinib today. So, that’s another case where a patient has done well being on osimertinib, who has had the EGFR T790M mutation in his tumor’s mechanism of resistance, to being on erlotinib.

Riess case 4:

52-year-old man with relapsed metastatic NSCLC.

  • 52-year-old man developed NSCLC, metastatic to the bone and brain
  • Was found to have an EGFR activating mutation
  • Started on erlotinib with a good response, received radiotherapy to hip and brain
  • After 12 months he developed cough and dyspnea on exertion
  • CT scan showed progression in the primary lesion and multiple other pulmonary nodules
  • Tissue biopsy showed an EGFR T790M mutation
  • Subsequent treatment with osimertinib resulted in tumor shrinkage as well as resolution of his symptoms.
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