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Lung Cancer Case Studies

Case Studies: A 63-Year-Old Woman With Metastatic EGFR-Mutated Non-Small Cell Lung Cancer

Edgardo Santos Castillero, MD, FACP, remarks on the case of a 63-year-old woman with metastatic EGFR-mutated non–small cell lung cancer and reacts to decisions to treat the patient with the combination of an EGFR tyrosine kinase inhibitor and VEGF inhibitor.

A 63-Year-Old Woman With Metastatic EGFR-Mutated Non-Small Cell Lung Cancer

Case: A 63-Year-Old Woman With Metastatic EGFR+ NSCLC

 

Initial presentation

  • A 63-year-old woman presented with persistent cough, and a 5-lb weight loss
  • PMH/SH: former smoker, quit 25 years ago
  • PE: Decreased breath sounds on auscultation in the right lower lobe

Clinical workup

  • Labs: WNL
  • PFT: FEV1/FVC 60%; DLCO 68%
  • Chest X-ray showed a right lower lobe soft tissue mass
  • Chest/abdominal/pelvic CT showed a 3.8-cm solid pulmonary mass in the right lower lobe; enlarged contralateral hilar and mediastinal lymph nodes; 3 small right adrenal lesions noted
  • CT‐guided core needle biopsy of the lung mass revealed lung adenocarcinoma; lymph node biopsy showed grade 2 adenocarcinoma
  • Contrast‐enhanced MRI of the head showed no evidence of brain metastases
  • Molecular testing: EGFR exon 21 substitution L858R, ALK-, BRAF-, ROS1-, RET-, MET-, ERBB2-, PD-L1 TPS 14%
  • Staging- T2aN3M1b - IVA; ECOG PS 0

Treatment

  • Patient was started on erlotinib 150 mg PO qDay + ramucirumab 10 mg/kg IV
    • Imaging at 3-month showed partial response with decrease in lung lesion
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