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Opinion|Videos|December 19, 2023
An overview on KRAS+ mutated lung adenocarcinoma
Author(s)Joshua K. Sabari, MD
Background on KRAS mutations in lung adenocarcinoma, including the prevalence, prognosis, and challenges in treating patients with NSCLC.
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Episodes in this series
Case: A 64-year-old male diagnosed with a KRAS G12C mutated stage IV adenocarcinoma
Clinical Presentation:
- A 64-year-old male presents with cough and fatigue
- PMH: hyperlipidemia (well controlled with simvastatin), GERD (takes Omeprazole)
- SH: married with 2 grown children who live in other states; 30 pack-year smoking history; no family history of cancer.
Initial Clinical Workup and Diagnosis:
- CT chest showed right upper lobe lung mass with contralateral lung nodules concerning metastases.
- PET/CT revealed additional metastases in the liver.
- Molecular Testing: KRAS G12C mutation
- Staging: IV adenocarcinoma; ECOG PS 1
Initial Treatments:
- Patient was initiated on carboplatin-pemetrexed + pembrolizumab.
- Good initial response after 4 cycles but progressed after 8 months.
Disease Progression and Subsequent Treatments:
- Experienced disease progression after 8 months of carboplatin-pemetrexed + pembrolizumab, notably growth in hepatic metastases
- Confirmed progression on CT and PET/CT scans
- After progression on initial chemo+IO, molecular testing confirmed retained KRAS G12C mutation.
- The patient then started on second-line therapy with the adagrasib.
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