Stage IV EGFR-mutated lung cancer with acquired resistance to osimertinib

This lung cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Subtype
Adenocarcinoma
Biomarkers
EGFR L858R; acquired EGFR T790M; acquired EGFR L718Q
Sex
Female
Spread to
pleura, bone
Treatment
targeted therapy and radiation
Outcome
Setback / Progression

Treatment course, step by step

  1. Started gefitinib in October 2016 and achieved a partial response.
  2. Switched to osimertinib in April 2018 after progression with pleural disease and an acquired EGFR T790M mutation.
  3. Started dacomitinib with radiation to bone metastases in April 2020 after an acquired EGFR L718Q mutation was found.
  4. Later self-administered cabozantinib after further progression.

What happened, in summary

A 77-year-old woman was diagnosed in October 2016 with Stage IV lung adenocarcinoma after imaging showed a right lung mass, pleural effusion and enlarged chest lymph nodes. Testing found an EGFR L858R mutation. She started gefitinib and achieved a partial response that lasted for months.

In April 2018, worsening pleural disease was accompanied by an acquired EGFR T790M mutation. She switched to osimertinib and again achieved a partial response. Two years later, she developed bone metastases in the thoracic and lumbar spine and progression in the lung. Testing then showed a new EGFR L718Q resistance mutation alongside L858R.

She started dacomitinib and received radiation to the bone metastases. The cancer was stable after two months but progressed again after eight months. She then used cabozantinib, with temporary stable disease, but by June 2021 the right lung lesion had enlarged again. She remained alive at the last follow-up.

Where this story comes from

This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full

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These are lay summaries of published cancer stories, for information only. No two cancers behave the same way, and nothing here predicts your own diagnosis or replaces advice from your oncology team. Read the full disclaimer

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