A 68-Year-Old Man With Metastatic EGFR+ NSCLC

Case:A 68-Year-Old Man With Metastatic EGFR+ NSCLC

Initial presentation

• A 68-year-old man presented with recent onset shortness of breath and unintentional weight loss; he denies nausea, vomiting or headaches
• PMH: Hyperlipidemia controlled on a statin; former smoker, quit 10 years ago with a 30 pack-year history
• PE: Decreased breath sounds in left lower lung field on auscultation
  
  

Clinical workup

• Labs: WNL
• PFT: FEV1/FVC 55%; DLCO 65%
• Chest X-ray showed a left lower lobe soft tissue mass
• Chest/abdominal/pelvic CT showed a 3.3-cm solid pulmonary mass involving the left main bronchus and ipsilateral subcarinal lymph nodes, and adrenal metastases
• CT-guided core needle biopsy lung lesion and lymph nodes revealed grade 2 lung adenocarcinoma
• Contrast‐enhanced MRI of the brain was negative
• Molecular testing: EGFR exon 19 deletion, ALK-, ROS1-, BRAF-, PD-L1 TPS 20%
• Stage IVA – T2N2M1a; ECOG PS 1
  
  

Treatment

• Patient was started on erlotinib 150 mg PO qDay + ramucirumab 10 mg/kg IV q2weeks
  • Imaging at 3-month showed partial response with decrease size of lung and adrenal lesions
  • Imaging at 6-, 12- and 18-month follow-up showed stable disease