What happened, in summary

A 64-year-old man who had never smoked presented in April 2017 with cough, small amounts of blood in his sputum and worsening shortness of breath. Imaging showed a large right lower-lung mass with extensive chest lymph-node involvement, and biopsy confirmed acinar lung adenocarcinoma. The cancer was initially Stage III. He began cisplatin plus vinorelbine and had substantial early tumor shrinkage, but the disease later progressed. Molecular testing then identified a compound EGFR mutation, L858R with S768I, and he switched to afatinib. The targeted therapy produced marked improvement and more than 3 years of disease control. Bone metastases appeared in December 2020, followed by a brain metastasis in April 2021, establishing Stage IV disease. He died on August 15, 2022, about 5 years and 4 months after his original presentation.