A medical oncologist provides an overview of treatment options available for patients with EGFR+ non–small cell lung cancer.
Case: A 73-Year-Old Man with EGFR+ NSCLC
Clinical Presentation:
Past Medical History:
Social History:
Initial Clinical Workup and Diagnosis:
Physical Examination
Pulmonary Function Tests
Imaging Studies:
Diagnostic Procedure:
Neoadjuvant Therapy and Surgical Resection:
Surgical Pathology Report:
Six Months Later:
Second Line Systemic Therapy:
Repeat Imaging at 8 Weeks:
This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Joshua K. Sabari, MD.
This video features a continuation of the discussion of the case of a 73-year-old former 50 pack-year smoker with stage IIA resected EGFR mutant non–small cell lung cancer (NSCLC) who developed recurrent metastatic disease 6 months after surgery. The speaker notes upfront next-generation sequencing should have been done, as knowing about the patient’s exon 21 L858R EGFR mutation earlier could have impacted neoadjuvant treatment recommendations instead of the carboplatin, pemetrexed, and nivolumab combination.
Now that the EGFR mutation is identified, there are several frontline options for recurrent metastatic NSCLC with common EGFR mutations like exon 19 deletions and L858R, including osimertinib monotherapy, osimertinib plus chemotherapy, and the recent MARIPOSA trial data of amivantamab plus lazertinib. An MRI of the brain should also have been done at recurrence given the high central nervous system metastasis risk with EGFR-mutated NSCLC.
For frontline treatment of recurrent EGFR-mutant metastatic NSCLC, the standard of care remains osimertinib, an EGFR tyrosine kinase inhibitor with 18.9-month progression-free survival in the FLAURA trial. Patients with exon 19 deletion have better outcomes than patients with L858R, and co-mutations like TP53 may worsen prognosis.
Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.
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