What happened, in summary

A 51-year-old non-smoking woman was diagnosed in August 2021 after routine imaging found a 5 cm mass in the left lower lung lobe. CT-guided biopsy confirmed lung adenocarcinoma. PET-CT showed high FDG uptake in the lung mass and moderate uptake in mediastinal lymph nodes on the same side, while brain MRI showed no intracranial metastasis. No distant metastasis was reported. Her clinical stage was T3N2M0, within Stage III disease. A multidisciplinary team chose neoadjuvant brigatinib followed by surgery. After 6 weeks of brigatinib, chest CT showed a partial response with significant tumor shrinkage. She then underwent left lower lobectomy with mediastinal lymph-node dissection. Surgical pathology showed a pathological response classified as pT1cN2, and spread through air spaces was negative. After recovery, she continued adjuvant brigatinib at 90 mg daily. Because residual nodal disease remained pathologically, continuing brigatinib after resection was a key part of management rather than a minor follow-up detail. At 27 months after surgery, PET-CT and brain MRI showed no evidence of disease. Her course is best summarized as Stage III lung adenocarcinoma treated with targeted neoadjuvant therapy, surgery, and adjuvant brigatinib, with durable disease-free follow-up. No chemotherapy, radiation, immunotherapy, or distant metastatic-site detail was described for this patient. The pathological response after brigatinib reduced the tumor burden from the original 5 cm presentation, but nodal involvement persisted, which explains why follow-up care included continued systemic targeted therapy. The negative brain MRI was especially relevant because brain metastases are a common concern in advanced lung adenocarcinoma surveillance over time.