What happened, in summary

A 65-year-old nonsmoking woman was diagnosed in June 2018 with Stage IV lung adenocarcinoma carrying an EGFR L858R mutation and multiple brain metastases. She had gait difficulty and reduced strength but had not received brain radiation. The following month, she joined a phase 1–2 clinical trial and started zorifertinib as first-line targeted therapy. Both the brain and extracranial tumors had partial responses, and her neurological symptoms completely resolved after 4 treatment cycles. She remained on zorifertinib for about 3 years before isolated pleural progression appeared. The brain metastases continued to respond, with more than 4 years of intracranial disease control. In 2022, pleural disease progressed further and testing identified an acquired EGFR T790M mutation. She switched to aumolertinib and remained on treatment for at least 13 months. By December 2023, she was still alive with overall survival of more than 65 months from treatment start. Her course shows more than 5 years living with metastatic EGFR-mutated lung cancer and multiple brain metastases without intracranial radiation.