45-Year-Old Never-Smoker with Advanced EGFR-Mutant NSCLC and CNS Metastases Treated with the MARIPOSA Regimen

Case Presentation 2 – Patient With Treatment Preferences

Main Discussion Topics:

• Management of a 45-year-old preschool teacher with significant anxiety about treatment
• Addressing a patient’s strong preference against chemotherapy
• Implementation of prophylactic strategies for adverse event management

Key Points for Physicians:

• Patient with EGFR exon 21 mutation, numerous brain metastases, and adamant preference against chemotherapy
• Amivantamab + lazertinib selected as a chemotherapy-free option with demonstrated overall survival and central nervous system (CNS) benefits
• Comprehensive prophylactic measures implemented (dexamethasone premedication, skin prophylaxis, anticoagulation)

Notable Insights:

Patient education involved balancing data-driven information about efficacy with counseling about expected toxicities and management strategies.

Clinical Significance:

This case demonstrates how treatment selection can be successfully tailored to align with patient preferences while still providing optimal efficacy for high-risk disease features.