February 20, 2020

Case: A 64-Year-Old Male with Untreated Stage IVEGFRMutated NSCLC

Initial presentation

  • A 64-year—old 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


  • 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