What happened, in summary

A 66-year-old man was diagnosed in 2012 with Stage II adenocarcinoma of the right lower lung carrying an EGFR L858R mutation. He underwent right pneumonectomy with lymph-node dissection and then took tegafur-uracil for 2 years. In 2015, pleural recurrence led to erlotinib, which controlled the disease for 52 months. When a chest-wall and rib lesion was resected in 2019, pathology showed combined small-cell lung cancer alongside adenocarcinoma, and testing identified an acquired EGFR T790M mutation. He then received carboplatin plus etoposide. Further progression brought brain metastasis and additional chest disease, followed by stereotactic radiation with amrubicin and later irinotecan. In 2021, progression in the opposite lung and cancerous meningitis led to osimertinib and whole-brain radiation. His condition deteriorated quickly, and osimertinib could be continued for only 12 days. He died in September 2021, more than 9 years after the original diagnosis. His course illustrates prolonged survival despite repeated resistance, histologic transformation and multiple metastatic relapses.