What happened, in summary

A 66-year-old man presented in early 2019 with cough, sputum, and shortness of breath. Imaging and malignant pleural fluid established Stage IV lung adenocarcinoma. Initial molecular testing found an EGFR exon 19 deletion. After one cycle of carboplatin plus pemetrexed, he switched to icotinib and achieved a partial response that lasted about 17 months before slow progression. A later biopsy showed pulmonary enteric adenocarcinoma and acquired EGFR T790M, along with MSI-high disease and a high tumor mutation burden. Osimertinib produced only about 3 months of benefit. He then received several chemotherapy regimens, including bevacizumab-containing treatment, followed by camrelizumab alone and with chemotherapy. Later plasma testing no longer detected T790M, and he received gefitinib plus everolimus. The cancer continued to progress amid pulmonary complications. He died approximately 30 months after his original diagnosis.