EGFR-Mutant Lung Cancer With Pleomorphic Transformation Treated With Local Surgery
This lung cancer diagnosis at a glance
- Stage at diagnosis
- Stage IV
- Subtype
- Adenocarcinoma
- Biomarkers
- EGFR L858R mutation; PD-L1 less than 1% initially and greater than 75% after transformation
- Sex
- female
- Spread to
- brain
- Treatment
- radiation, targeted therapy and surgery
- Outcome
- Responding Well
Treatment course, step by step
- Received gamma-knife radiation for brain metastases and then started osimertinib, achieving a partial response.
- After isolated regrowth of the primary lung tumor about 46 months later, underwent surgical resection while continuing osimertinib.
- Pathology showed transformation to pleomorphic carcinoma, and osimertinib was continued after surgery.
What happened, in summary
A 66-year-old woman who had never smoked was diagnosed with Stage IV lung adenocarcinoma. Imaging showed a 44-mm tumor in the left upper lung, pleural disease, and a brain metastasis. Molecular testing found an EGFR L858R mutation, while PD-L1 expression was initially below 1%.
She first received gamma-knife radiation for the brain metastasis and then started osimertinib. The lung tumor shrank and the pleural fluid decreased, producing a partial response. This control lasted for almost 4 years. About 46 months after starting osimertinib, the primary lung tumor began to grow again, while no other new metastatic sites were seen.
Because the progression was limited to the lung tumor, it was surgically removed about 47 months after osimertinib began. Pathology showed that part of the tumor had transformed from adenocarcinoma into pleomorphic carcinoma, a more aggressive histologic form. The EGFR L858R mutation was still present, and PD-L1 expression had risen to above 75%.
She continued osimertinib after surgery. At 9 months of postoperative follow-up, no recurrence had been seen and she remained on osimertinib. Her course shows prolonged control of metastatic EGFR-mutant lung cancer with targeted therapy plus local treatment for isolated progression.
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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Collections this story belongs to
- Stage 4 Lung Cancer 384 stories
- Stage 4 EGFR Mutation Lung Cancer 74 stories
- EGFR Mutation Lung Cancer 112 stories
- Osimertinib for EGFR Mutation Lung Cancer 56 stories
- Osimertinib for Lung Cancer 65 stories
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