Osimertinib Improved Spinal Cord Metastases in Long-Standing Lung Cancer

Patient Info: Anonymized, Male, 50s | Stage IV

Biomarkers: Initial surgical specimen: no detected EGFR mutation and ALK-negative. Later pleural-fluid tumor: acquired EGFR T790M mutation with no other detected EGFR mutation.

Metastatic Site: cervical and mediastinal lymph nodes; bone; brain;…

Osimertinib improved neurologic function and kept the lung cancer stable for 14 months; he later died from bacterial pneumonia.

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HER2-amplified metastatic colon cancer treated with afatinib after several therapies

Patient Info: Anonymized, Male, 60s | Stage IV

Biomarkers: RAS wild-type; BRAF wild-type; HER2 amplification; HER2 mutation

Metastatic Site: liver|abdominal wall|lung

After multiple treatment lines and a 3-month period of stable disease on afatinib, the cancer progressed again. He died in January 2018 from severe lung infection and kidney failure.

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Stage IV ERBB2-Mutated Lung Adenocarcinoma Responding to HER2-Targeted Therapy

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: ERBB2 exon 20 insertion

Metastatic Site: bilateral lungs

Afatinib showed a response after 1 month, but insurance denial required a return to trastuzumab-based treatment.

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Stage IV ERBB2-Mutated Lung Adenocarcinoma With Brain Metastases and Multiple Targeted Therapies

Patient Info: Anonymized, female, Under 40 | Stage IV

Biomarkers: ERBB2 exon 20 insertion, exact sequence not specified. ERBB2 copy-number gain was identified during progression on afatinib.

Metastatic Site: brain, adrenal gland, liver

The final documented afatinib plus bevacizumab rechallenge produced a mixed response followed by liver progression after 3 months.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Leptomeningeal Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation with amplification

The final treatment produced a mixed systemic response, but leptomeningeal disease developed.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Treatment Intolerance and Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation

After poorly tolerated earlier regimens with stable disease, he developed symptomatic progression during 1 month of afatinib.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma Progressing Through Multiple Therapies

Patient Info: Anonymized, female

Biomarkers: ERBB2 mutation

The cancer progressed during afatinib, nivolumab and a later paclitaxel rechallenge.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Progression Across Multiple Regimens

Patient Info: Anonymized, male

Biomarkers: ERBB2 V777delinsVGSP mutation

After a brief period of stable disease on cisplatin plus docetaxel, the cancer progressed through erlotinib, gemcitabine and afatinib.

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Afatinib Controlled EGFR-Mutant Metastatic Lung Cancer After Erlotinib Caused Pneumonitis

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: EGFR-mutant

Metastatic Site: contralateral lung, pleura

At the last follow-up, she remained on afatinib with stable metastatic lung cancer almost 3 years after diagnosis and no recurrence of the pneumonitis.

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EGFR-mutated lung cancer on AZD9291 clinical trial with improved symptoms

Patient Info: Anonymized, Male

Biomarkers: EGFR mutation

On 20 July 2016, the patient was on AZD9291 through a clinical trial, toxicity checks were reassuring, symptoms felt improved, and the next CT was planned for late August.

Lung cancer progression with T790M-positive tissue result and AZD9291 trial start

Patient Info: Anonymized, Male | Stage Metastatic/Advanced

Biomarkers: resistance detected in tissue biopsy

On 5 June 2016, CT showed lung tumor progression after afatinib, but a tissue T790M result allowed entry into an AZD9291 clinical trial and treatment had just started.

Lung adenocarcinoma with squamous-cell component on afatinib while awaiting June CT

Patient Info: Anonymized, Male

Biomarkers: resistance no longer detected in later liquid biopsies; squamous-cell component described in bronchial biopsy pathology

On 8 May 2016, the patient was continuing afatinib/Giotrif for lung cancer with adenocarcinoma and squamous-cell features, waiting for a June CT to judge response after about 5 months of treatment.

T790M-negative lung cancer on afatinib after AZD9291 trial ineligibility

Patient Info: Anonymized, Male

Biomarkers: T790M-negative blood test; EGFR/TKI treatment context

On 21 April 2016, the patient was not eligible for the AZD9291 trial because the blood sample was T790M-negative, so he continued afatinib/Giotrif while weighing future options and advance-care preferences.

Lung cancer progression on afatinib with T790M testing for AZD9291 trial eligibility

Patient Info: Anonymized, Male | Stage Metastatic/Advanced

Biomarkers: resistance testing pending

On 14 April 2016, CT showed the right upper-lobe lung tumor had grown despite afatinib/Giotrif, prompting T790M testing and discussion of AZD9291 trial eligibility or radiotherapy.

Lung cancer on afatinib with liquid-biopsy monitoring and CT pending

Patient Info: Anonymized, Male

Biomarkers: Liquid biopsy drawn for resistance monitoring; specific result pending

On 20 March 2016, the patient was continuing afatinib/Giotrif, had blood drawn for liquid-biopsy resistance monitoring, and was waiting for a new CT appointment.

Lung cancer on afatinib after liquid biopsy showed T790M resistance no longer detected

Patient Info: Anonymized, Male

Biomarkers: resistance to erlotinib no longer detected in latest liquid-biopsy blood sample

On 21 February 2016, the patient was continuing afatinib/Giotrif after liquid-biopsy monitoring no longer detected T790M resistance, while managing diarrhea, nausea, mucositis, and skin/eye irritation.

Lung cancer with acquired T790M resistance: erlotinib switched to afatinib while AZD9291/TAGRISSO trial was considered

Patient Info: Anonymized, Male | Stage Metastatic/Advanced

Biomarkers: Acquired resistance detected; other resistance findings also mentioned

As of January 2016, he had reached 2 years of survival but had confirmed acquired resistance including T790M, worsening symptoms, and a treatment change from erlotinib to afatinib while a TAGRISSO/AZD9291 trial was being considered.

EGFR-mutated lung cancer diary: PET-scan anxiety during treatment break

Patient Info: Anonymized, Male

Biomarkers: EGFR mutation

As of December 2014, the patient had been off treatment for 6 months with limited symptoms and was awaiting a PET scan to determine whether treatment should restart.