What happened, in summary

A 68-year-old man with a smoking history was diagnosed in January 2016 with invasive nonmucinous lung adenocarcinoma. He underwent right lower lobectomy with mediastinal lymph-node dissection in March 2016, followed by 2 cycles of cisplatin and pemetrexed. Chemotherapy was stopped when imaging and biopsy confirmed recurrent metastatic disease in the right lung.

Nivolumab was given every 2 weeks from September to November 2016. Imaging initially showed a good response, but treatment was later stopped because of immune-mediated hepatitis and cancer progression. Slow progression continued during the following year. RNA sequencing of the original surgical tissue identified an SDC4-NRG1 fusion.

Afatinib started in August 2018 at 30 mg daily. The disease remained stable for 4 months, then progressed rapidly in December. He decided against further cancer-directed treatment and entered hospice, where he died shortly afterward.