ERBB2-Mutated Metastatic Lung Adenocarcinoma Progressing Through Multiple Therapies

What happened, in summary

A woman who had never smoked had metastatic lung adenocarcinoma with an ERBB2 L755A mutation. She received carboplatin and pemetrexed for 2 months, and the disease remained stable. Paclitaxel followed for 3 months and was interrupted by whole-brain radiation; the disease was again described as stable during this period. Afatinib was then given for 1.5 months, but the cancer progressed. Nivolumab followed for 2 months, with 2 cycles of paclitaxel given between doses, and progression continued. A later paclitaxel rechallenge, started 2 months after the prior dose, was continued for 1 month before another documented progression. Her treatment course moved from temporary disease stability to repeated progression across chemotherapy, HER2-directed therapy and immunotherapy.