What happened, in summary

A 44-year-old woman who had never smoked underwent curative surgery for Stage I lung adenocarcinoma in January 2019. The tumor carried an EGFR exon 19 deletion. After surgery, she received 4 cycles of pemetrexed and nedaplatin chemotherapy.

In 2020, new brain abnormalities, lung nodules, and pleural disease showed that the cancer had returned as Stage IV disease. She started the EGFR-targeted drug osimertinib. The brain lesions and scattered lung nodules disappeared, although a pleural mass persisted. Later imaging showed an adrenal metastasis, and a biopsy of the pleural mass in January 2022 revealed that the cancer had transformed from adenocarcinoma into small cell lung cancer.

She then received thoracic radiation with etoposide and cisplatin, which temporarily stabilized the disease. A thyroid metastasis later appeared and was also identified as small-cell neuroendocrine cancer of pulmonary origin. Treatment continued with irinotecan and then irinotecan plus atezolizumab. Despite this, liver metastases developed and the thyroid and adrenal tumors continued to grow, leading to additional radiation. When multiple brain metastases appeared, cranial radiation was started but only 2 treatments were completed.

She died on May 11, 2023, after 52.7 months of overall survival from the original lung-cancer diagnosis, with progressive cancer and organ failure.