EGFR Exon 20–Positive NSCLC: Future Directions in Care

Before closing out her discussion on novel therapy for EGFR exon 20–positive NSCLC, Zofia Piotrowska, MD, shares her hopes for future developments in care.

Case: A 59-Year-Old Female with Lung Cancer

Initial presentation

  • BC is a 59 y/o Asian female who presents to her physician complaining of shortness of breath, fatigue, and persistent right- sided neck pain.
    • BC believes she is experiencing neck pain because of her new sleeping pillow.
    • Since her last examination 6 months ago, BC has lost close to 10 lbs. BC has not changed her eating habits or style.
    • PMH: Hypercholesterolemia (controlled)
    • SMH: no history of smoking; drinks socially
    • FH: she lives with her partner and 2 dogs; mother passed away from ovarian cancer 3 years ago.
    • PE: LLL auscultation reveals decreased breath sounds visible bruising

Clinical workup

  • Current Labs:
    • CBC panel: Normal
    • Liver function/Renal function: Normal
  • CT Chest: LLL primary, mediastinal LNs; bone metastases
  • Diagnosis: Stage IV adenocarcinoma
  • MRI brain is negative for brain metastases
  • CT scan of abdomen and pelvis shows additional bone metastases
  • Weight: 120 lbs (54.5 kg)
  • Biopsy of mediastinal lymph nodes shows stage 4 lung adenocarcinoma
  • PD-L1 55%

Treatment

  • NGS has been ordered and the results are pending.
  • Patient initiated on a chemotherapy doublet.
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