March 4, 2020


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