What happened, in summary

A 65-year-old woman was diagnosed in August 2019 with lung adenocarcinoma that had already spread to the brain. She received stereotactic radiation to three brain metastases, followed by 4 cycles of pembrolizumab, carboplatin and pemetrexed and then maintenance pembrolizumab with pemetrexed. She also received focused radiation to a residual right-upper-lung mass.

When new cerebellar metastases developed, the larger lesion was removed surgically and another was treated with stereotactic radiation. Pathology confirmed that the brain lesion came from the lung adenocarcinoma. Molecular testing of the lung tumor identified BRCA2 and ATM mutations, with no EGFR or ALK alteration, and olaparib was started in November 2020.

The lung cancer remained controlled for about 30 months on olaparib. In February 2023, PET imaging was still overall stable apart from a newly detected breast lesion. Biopsy showed that the breast lesion was a separate triple-negative breast primary rather than progression of the lung cancer, allowing olaparib to be continued for the metastatic lung disease.