Selecting Frontline Therapy for KRAS+ mutated lung adenocarcinoma

Case: A 64-year-old male diagnosed with a KRAS G12C mutated stage IV adenocarcinoma

Clinical Presentation:

• A 64-year-old male presents with cough and fatigue
• PMH: hyperlipidemia (well controlled with simvastatin), GERD (takes Omeprazole)
• SH: married with 2 grown children who live in other states; 30 pack-year smoking history; no family history of cancer.

Initial Clinical Workup and Diagnosis:

• CT chest showed right upper lobe lung mass with contralateral lung nodules concerning metastases.
• PET/CT revealed additional metastases in the liver.
• Molecular Testing: KRAS G12C mutation
• Staging: IV adenocarcinoma; ECOG PS 1

Initial Treatments:

• Patient was initiated on carboplatin-pemetrexed + pembrolizumab.
  • Good initial response after 4 cycles but progressed after 8 months.

Disease Progression and Subsequent Treatments:

• Experienced disease progression after 8 months of carboplatin-pemetrexed + pembrolizumab, notably growth in hepatic metastases
  • Confirmed progression on CT and PET/CT scans
• After progression on initial chemo+IO, molecular testing confirmed retained KRAS G12C mutation.
  • The patient then started on second-line therapy with the adagrasib.