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Lung Cancer Case Studies

Case Studies: Treatment of NSCLC With Uncommon EGFR Mutations

Sarah Goldberg, MD, discusses a case scenario of a 66-year old woman with EGFR-positive metastatic lung adenocarcinoma.

Treatment of NSCLC With Uncommon EGFR Mutations

  • A female patient, Chinese descent, aged 66, is referred from primary care with persistent cough, sputum with blood, shortness of breath and chest pain
  • History
    • Never smoked
    • Recurrent bronchitis over past 5 years
    • Has never been screened for lung cancer (by radiography or low-dose CT [LDCT])
    • Hypertension controlled on HCTZ; no diabetes, renal impairment
    • Family history
      • Grew up in China, moved to US at age 29; married for 30 years
      • Grew up in family with heavy smokers
      • Husband is current smoker
  • LDCT reveals multiple tumors in left lung with pleural metastases
  • Biopsy reveals non-small cell lung cancer
  • Molecular analysis:
    • EGFR mutation: G719X
    • Negative for ALK rearrangement
    • Wild-type KRAS
  • The patient was started on afatinib, 40 mg once daily
  • After one month on therapy, she reported having rather severe diarrhea (5 times/day)
  • Treatment was discontinued, then re-started treatment at 30 mg/day
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