What happened, in summary

A 61-year-old woman with EGFR-mutated lung cancer was treated with osimertinib for 14 months. At progression, the tumor had transformed into small cell lung cancer. The EGFR exon 19 deletion was still present, and testing also found an acquired MET amplification. A TP53 p.R110P alteration had been present in the original tumor. Because of the MET amplification, she received the MET inhibitor tepotinib together with osimertinib. The cancer progressed again 5 months later. She then switched to carboplatin and etoposide chemotherapy combined with the PD-L1 inhibitor atezolizumab. She continued that regimen for 7 months before her death. Her treatment course required repeated changes as the lung cancer developed both a new histologic form and a new resistance alteration during targeted therapy.