A 64-Year-Old Male with Untreated Stage IV EGFR-Mutated NSCLC
February 20, 2020
A 64-Year-Old Male with Untreated Stage IV EGFR-Mutated NSCLC
Case: A 64-Year-Old Male with Untreated Stage IVEGFRMutated NSCLC
Initial presentation
A 64-yearold man presented with shortness of breath, productive cough, chest pain, fatigue, anorexia and an 8-lb weight loss.
PMH: HTN, medically controlled
SH: non-smoker, social alcohol use
PE: tired-appearing man, decreased breath sounds on auscultation
Clinical workup
Imaging:
Chest x-ray showed a left lower lobe mass
Chest/abdomen/pelvic CT scan confirmed a node extension, a 4.7-cm left lower lobe mass with mediastinal and hilar lymphadenopathy; left-sided adrenal metastases noted
PET scan showed activity in the left lower lobe mass and hilar nodal areas
Brain MRI showed no evidence of metastases
Staging: T3N3M1a - IVA adenocarcinoma; ECOG PS 1
Bronchoscopy with transbronchial biopsy of the left lower lobe was minimal and insufficient, subsequent plasma testing showedEGFRexon 19 deletion mutation
Treatment
Patient was started on osimertinib 80 mg PO qDay
At 3-week follow-up the patient had been tolerating treatment well; continued on therapy
Repeat Imaging at 3 months showed partial response
Follow-up at 6 and 9 months showed stable disease
At 18-months, CT scan revealed a new solitary liver lesion