Stage IV EGFR-Mutant Lung Adenocarcinoma With Severe Respiratory Failure Responding to Almonertinib

What happened, in summary

A 63-year-old woman developed rapidly worsening shortness of breath in late 2023 and was admitted in January 2024 with severe respiratory failure. Imaging showed widespread abnormalities in both lungs and enlarged mediastinal lymph nodes. Her breathing deteriorated despite high-flow oxygen, and she required intensive care and mechanical ventilation.

Testing of cells from bronchoalveolar lavage supported lung adenocarcinoma, and blood-based genetic testing found an EGFR exon 19 deletion. The cancer was classified as Stage IV.

Because she was critically ill, oral almonertinib was started as first-line targeted therapy while she remained intubated. Within several days, chest imaging showed partial improvement in the lung abnormalities. She was successfully taken off the ventilator 4 days after starting treatment and later transferred out of intensive care.

Continued almonertinib produced further radiographic and clinical improvement, and she was discharged at the end of January. A PET-CT in March 2024 showed satisfactory overall disease control with a partial response of the primary lesion. Monthly outpatient follow-up continued, and she remained free of shortness of breath with good functional status.