ERBB2-Mutated Stage III Lung Cancer With Liver Recurrence and Multiple Lines of Therapy

What happened, in summary

A 64-year-old woman with minimal smoking history was diagnosed in early 2011 with Stage III poorly differentiated lung adenocarcinoma. She received cisplatin and pemetrexed for 2 months before surgical resection and later completed definitive chemoradiotherapy. The cancer subsequently recurred, with metastatic disease mainly involving the liver. A clinical-trial regimen of carboplatin, gemcitabine and bevacizumab followed by gemcitabine and bevacizumab maintenance kept the disease stable for 6 months. After progression, docetaxel for 1 month was followed by rapid progression. Pemetrexed for 2.5 months and irinotecan for 2 months also failed to control the disease, which eventually involved much of the liver. Molecular testing then identified an ERBB2 exon 20 insertion. She started vinorelbine plus trastuzumab and experienced radiographic stable disease together with meaningful clinical improvement for another 6 months. The cancer later progressed in all sites. At that point, after a long sequence of chemotherapy, radiation, surgery and HER2-directed treatment, she chose hospice care.