Patient Profile: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer

Opinion
Video

Sandip P. Patel, MD, reviews the case of a 60-year-old woman with early-stage non–small cell lung cancer (NSCLC).

Case: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer

Initial presentation and Clinical Workup

  • Healthy 60-year-old Caucasian woman, 45 pack-year smoker, presented with a nonproductive cough
    • Physical exam revealed ECOG PS 0, BP: 120/93, HR: 74 bpm, BMI: 22
    • Pulm: lungs CTA bilaterally
    • Chest X-Ray: 5.5-cm right mass in right upper lobe
    • CT chest/abdomen: lobulated 5.5 x 5.1-cm mass in right upper lobe
    • Biopsy of Right Upper Lobe: adenocarcinoma, TTF1 (+) consistent with NSCLC
    • Labs are WNL; PET Imaging: negative for any lymph nodes or distant metastasis; Brain MRI: negative; PFTs: Normal

Treatment 

  • Mediastinoscopy with negative lymph nodes on frozen section, followed by right upper lobectomy without complications
  • Current ECOG PS remains 0
  • Histopathology reveals 5.5-cm tumor with negative margins; 0 nodes positive for malignancy (2R, 4R, 7, and 11R are all negative)
  • Patient is diagnosed with stage IIA (pT3N0M0) lung adenocarcinoma
  • Molecular testing shows EGFR exon (19del) and PD-L1 expression of 40%.
  • Post operation, the patient completes 4 cycles of adjuvant chemotherapy with cisplatin + pemetrexed. Her ECOG PS is 1.
  • Patient begins treatment with osimertinib. 20 months after initiating osimertinib, the patient reports headaches and worsening fatigue.
  • CT scans revealed 3 new liver lesions and Brain MRI visualized 1 new lesion.

This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Sandip P. Patel, MD.

This case involves a 60-year-old Caucasian female with a 45 pack-year smoking history who presented with a nonproductive cough and was found to have a 5.5-cm right upper lobe lung mass on imaging. Biopsy showed TTF-1–positive adenocarcinoma consistent with non-small cell lung cancer (NSCLC). Staging workup was negative for lymph node involvement or distant metastases. The patient underwent right upper lobectomy with clear margins. Pathology showed a 5.5-cm tumor, pathologic T3N0M0 (stage IIA) lung adenocarcinoma. Molecular testing revealed an EGFR exon 19 deletion and 40% PD-L1 expression.

Postoperatively, the patient completed adjuvant cisplatin and pemetrexed therapy. Due to the EGFR mutation, she was started on osimertinib. Twenty months after initiating osimertinib, she developed headaches and worsening fatigue. Imaging showed 3 new liver lesions concerning for metastases and 1 new potential central nervous system lesion.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.

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