A 63-Year-Old Woman With Metastatic EGFR-Mutated Non-Small Cell Lung Cancer

Case: A 63-Year-Old Woman With MetastaticEGFR+ NSCLC

Initial presentation

• A 63-year-old woman presented with persistent cough, and a 5-lb weight loss
• PMH/SH: former smoker, quit 25 years ago
• PE: Decreased breath sounds on auscultation in the right lower lobe

Clinical workup

• Labs: WNL
• PFT: FEV₁/FVC 60%; DLCO 68%
• Chest X-ray showed a right lower lobe soft tissue mass
• Chest/abdominal/pelvic CT showed a 3.8-cm solid pulmonary mass in the right lower lobe; enlarged contralateral hilar and mediastinal lymph nodes; 3 small right adrenal lesions noted
• CT‐guided core needle biopsy of the lung mass revealed lung adenocarcinoma; lymph node biopsy showed grade 2 adenocarcinoma
• Contrast‐enhanced MRI of the head showed no evidence of brain metastases
• Molecular testing:EGFRexon 21 substitution L858R, ALK-, BRAF-, ROS1-, RET-, MET-, ERBB2-,PD-L1 TPS 14%
• Staging- T2aN3M1b - IVA; ECOG PS 0

Treatment

• Patient was started on erlotinib 150 mg PO qDay + ramucirumab 10 mg/kg IV
  • Imaging at 3-month showed partial response with decrease in lung lesion