What happened, in summary

A 60-year-old man with a long smoking history had been followed for several small ground-glass lung nodules. In May 2023, a new solid mass was found in the right lower lobe with involved hilar and mediastinal lymph nodes. Biopsy confirmed lung adenocarcinoma, and the disease was classified as Stage III. Tumor testing found a MET exon 14 skipping mutation and a TP53 mutation.

The cancer was considered potentially resectable. After discussing standard chemoradiation and induction options, he chose targeted treatment before surgery. He first started savolitinib, but it was stopped after severe liver toxicity. After recovery, he switched to tepotinib.

Imaging showed a marked response, with the lung mass shrinking from about 3.4 cm to about 1 cm and no suspected remaining mediastinal nodal disease. He then underwent right lower lobectomy with lymph-node dissection in January 2024. All 25 removed lymph nodes were free of cancer, and the postoperative pathologic stage was Stage I.

He continued tepotinib after surgery. Blood-based tumor DNA testing no longer detected the MET alteration at early postoperative checks, and no cancer relapse was seen at the 6-month follow-up.