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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Advanced metastatic lung cancer with bone metastases, pneumonia, and worsening pain

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: Bone

By March 2017, he described worsening metastatic lung cancer with bone lesions, recent pneumonia, severe pain, and concern that AZD9291 might no longer be effective.

Metastatic Colon Cancer With Tumor Thrombus Extending Into the Right Atrium

Patient Info: Anonymized, female, 40s

Biomarkers: BRAF wild-type, KRAS wild-type, NRAS wild-type

Her metastatic colorectal cancer progressed despite multiple treatment lines. Supportive care alone was chosen after her performance status deteriorated, and she later died from multiorgan failure in the setting of metastatic cancer.

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Stage IV HER2-Positive Breast Cancer: Sarah's Patient Story

Patient Info: Sarah, Female, Under 40 | Stage IV

Biomarkers: HER2-positive; BRCA and other known hereditary breast cancer genes not identified in family history discussion

As of January 2017, Sarah had been living for almost 3 years with recurrent Stage IV HER2-positive breast cancer and was receiving Kadcyla every 3 weeks.

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Stage IV Breast Cancer: Debora's Patient Story

Patient Info: Debora, Female, 60s | Stage IV

Debora was living with metastatic breast cancer after Stage III disease treated with surgery, chemotherapy, radiation therapy, and targeted therapy; four years after surgery, she was told the cancer had metastasized and was on targeted therapy.

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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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BRCA1 Non-Small Cell Lung Cancer: Nadine's Survivor Story

Patient Info: Nadine Beech, Female, Under 40

Biomarkers: Germline BRCA1 mutation for hereditary breast/ovarian cancer risk; lung cancer biomarker not reported

As of November 2016, Nadine was cancer-free after right bilobectomy for recurrent non-small cell lung cancer, following 19 years of lung cancer management that included left lower lobectomy, surveillance, Tarceva, and risk-reducing surgery for germline BRCA1.

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Metastatic lung cancer controlled on AZD9291 clinical trial with tracheal narrowing under review

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: Metastasis mentioned; site not specified in this entry

On 20 November 2016, the patient’s tumor and metastasis appeared controlled on AZD9291 and the disease was not considered progressive, though tracheal narrowing required closer review and earlier follow-up.

Living with lung cancer: AZD9291 toxicity check, pain control, and social isolation story

Patient Info: Anonymized, Male

On 9 October 2016, the patient was living with lung cancer on AZD9291, had a reassuring toxicity check, and was managing ongoing physical pain and social isolation while waiting 6 weeks for the next CT.

Metastatic lung cancer on AZD9291 with a left iliac bone lesion

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: Bone: left iliac bone

On 18 September 2016, the patient was living with lung cancer on AZD9291 after MRI confirmed a solitary left iliac bone lesion suspicious for metastasis, with radiotherapy deferred and the next CT planned for November.

Lung Adenocarcinoma Metastatic to the Breast With Inflammatory Breast-Like Symptoms

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

Biomarkers: EGFR positive. Breast metastasis: TTF-1 positive

Metastatic Site: right breast

A PET scan after breast radiation showed no metabolically active cancer, but she died 2 months after the breast metastasis was diagnosed.

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Stage III Inflammatory Breast Cancer Diagnosed After Severe Breast Pain and Swelling Following Mammography

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

Biomarkers: ER negative, PR negative, HER2 highly positive

After later metastatic disease was found, she chose no further active treatment and died of progressive disease in 2012.

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Lung cancer on AZD9291 with tumor shrinkage and new suspected iliac bone metastasis

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: Bone: left sacroiliac/iliac region

On 28 August 2016, AZD9291 had reduced the lung mass and stabilized nodes, but CT also showed a new suspected left iliac/sacroiliac bone metastasis requiring MRI workup.

HER2-Positive Right Breast Cancer With Complete Response Before Bilateral Mastectomy

Patient Info: Anonymized, female, 50s

Biomarkers: ER negative, PR negative, HER2 positive

After neoadjuvant treatment, imaging showed complete resolution of the right-breast mass and mastectomy pathology found no residual right-breast tumor or malignant right sentinel node.

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Metastatic Gastric Cancer Treatment Complicated by Acute Hypertension During Ramucirumab

Patient Info: Anonymized, male, 60s

After progression on first-line chemotherapy, he had started second-line ramucirumab-based treatment when an acute hypertensive infusion reaction was documented.

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Recurrent Gastric Cancer With Peritoneal Spread and Acute Hypertension During Ramucirumab

Patient Info: Anonymized, male, 70+ | Stage IV

Metastatic Site: peritoneum

Treatment was stopped after 2 cycles because of progression, no further cytotoxic treatment was started, and he died at home 19 weeks after the last chemotherapy.

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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.