A 60-Year Old Man With Untreated Stage IV EGFR-Mutated Non-Small Cell Lung Cancer

Case: A 60-Year-Old Male with Untreated Stage IVEGFR+NSCLC

Initial presentation

• A 60-year—old Caucasian man presented with shortness of breath, mild dry cough
• PMH: hyperlipidemia, hypertension, medically controlled
• SH: non-smoker, worked 40 years in ship-building industry
• PE: Lungs clear on auscultation bilaterally; anxious-appearing; acknowledges feeling nervous about his health

Clinical workup

• Imaging:
  • Chest x-ray showed a right bronchial lung mass
  • Chest/abdomen/pelvic CT scan revealed a 4.6-cm mass on the right main bronchus and ipsilateral subcarinal lymphadenopathy; positive for a single suspicious 2-cm hepatic lesion on the right lobe
  • PET scan showed activity in the right main bronchus and subcarinal nodal area, hepatic lesion was shown to be avid
  • Brain MRI negative for metastases
• Patient underwent bronchoscopy with TBNA
• Diagnosis and staging: Biopsy showed high-grade lung adenocarcinoma; T2N2M1b — IVA
• Molecular testing:EGFRexon 21 L858R, PD-L1 TPS 50%
• ECOG PS 0

Treatment

• Patient started on osimertinib 80 mg PO qDay
  • At 3-week follow-up the patient had been tolerating treatment well; continued osimertinib
• Repeated chest/abdomen/pelvic CT with contrast after every 2 cycles,
  • Partial response after 4 cycles, no disease progression at 3, 6 and 12 months
• Imaging at 19-month follow-up revealed a new solitary liver lesion