A 60-Year Old Man With Untreated Stage IV EGFR-Mutated Non-Small Cell Lung Cancer - Episode 1
Martin Dietrich, MD, PhD:In today’s session, we’re discussing a 60-year-old Caucasian male with a new diagnosis of nonsmall cell lung cancer. He presented initially to the emergency department with mild dyspnea and worsening dry cough. He had no significant past medical history, only hypercholesterolemia and hypertension. He had a social history that was interesting because he was a never-smoker, but he had occupational exposure in the shipbuilding industry for 40 years. On physical examination, he was nervous and appeared anxious. He had mild dyspnea with tachypnea, roughly 22 respirations per minute, but otherwise it was an unremarkable exam.
On initial imaging, the patient was found to have a right hilar mass on chest x-ray. This was confirmed on the CT [computed tomography] scan of the chest, abdomen, and pelvis, in which he was found to have a large right hilar mass of 4.6 cm, a subcarinal lymph node conglomerate, and a right hepatic lobe lesion of roughly 2 cm that was deemed to be suspicious. He further underwent a PET [positron emission tomography]/CT scan that was positive for avidity in the liver lesion, and then he underwent biopsy of the right liver lobe lesion and was found to have a pulmonary adenocarcinoma. His molecular markers demonstrated a PD-L1 [programmed death-ligand 1] level of 50% and anEGFRexon 21 L858R substitution, a phenotype that is quite uncommon, a combination of 2 markers. And he was started, based on the FLAURA trial data, on osimertinib, 80 mg daily.
He tolerated the medication well, and he had a very good response for about 19 months, at which point he was found to have a new isolated liver metastasis and underwent further work-up for additional treatment recommendations.
The patient’s diagnosis is a stage IV adenocarcinoma of the lung. It’s the most common subtype of lung cancer histologically,EGFRbeing the only large, targetablecurrently at least—subtype, which is a positive finding for the patient. And that translates into an improved prognosis prior to previous treatments, with an expectation of roughly 36 months in median overall survival.
Transcript edited for clarity.
Case: A 60-Year-Old Male with Untreated Stage IVEGFR+NSCLC