What happened, in summary

A 55-year-old woman who had never smoked was diagnosed with Stage IV lung adenocarcinoma. Cancer cells were found in pleural and pericardial fluid, and imaging also showed spread to the sternum. Testing identified an EGFR L858R mutation and a PIK3CA mutation.

She first received gefitinib with palliative radiation, then changed to afatinib plus bevacizumab. The cancer initially shrank, but several months later the lung tumor and pleural disease progressed. Repeat molecular testing found an acquired ROS1 rearrangement while the original EGFR mutation remained present.

She then tried osimertinib plus crizotinib, but both drugs had to be stopped quickly because of significant side effects, including an abnormal heart rhythm and severe leg swelling. Her treatment was changed to carboplatin and pemetrexed.

After 6 cycles, imaging showed a partial response across the lung, pleural, pericardial, and lymph-node disease. She then continued maintenance pemetrexed. At the latest follow-up, the partial response had remained sustained for about 7 months after chemotherapy began.