Real-World Use of Targeted Agents in EGFR Exon 20–Positive NSCLC

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.