What happened, in summary

An 81-year-old man was diagnosed with Stage IV lung adenocarcinoma after evaluation for shortness of breath and a large pleural effusion. Imaging showed pleural disease, extensive lymph-node involvement and multiple bone metastases. Tumor testing found an EGFR S768I mutation together with a V774M variant, while PD-L1 expression was low at 2%.

Because of his health and other medical conditions, he first received metronomic vinorelbine. When the cancer progressed, he switched to carboplatin and completed six cycles, but scans again showed worsening thoracic and skeletal disease.

He then started osimertinib in May 2023. His breathing and functional status improved. Early imaging showed shrinking lung disease despite temporary skeletal progression, so treatment continued because he was benefiting clinically. By December 2023 imaging showed a metabolic complete response, and a March 2024 scan confirmed a near-complete response. He remained on osimertinib with good tolerance and stable clinical condition.