Bone-Predominant EGFR L858R NSCLC With Multiple Comorbidities

Edgardo Santos, MD, FACP, FASCO, of Starling Oncology, presents the second clinical scenario in this OncLive My Treatment Approach discussion with Wade Iams, MD, MSCI, of Tennessee Oncology: a retired man and former smoker with weight loss, fatigue, and right-sided back pain. Imaging shows a 3.6-cm right lower lobe mass and multiple bone metastases, including a rib and a vertebral body without cord compromise. Brain magnetic resonance imaging shows no intracranial disease. Biopsy shows adenocarcinoma. Tissue next-generation sequencing was quantity-insufficient on first pass, and plasma circulating tumor DNA returned an EGFR L858R mutation. Because of symptomatic disease burden, he received 1 cycle of carboplatin while molecular results were pending. Comorbidities include type 2 diabetes, hypertension, and chronic kidney disease stage 3a, plus a provoked deep vein thrombosis after knee replacement, with low-dose aspirin only. This is stage IVB disease with a performance status of 1.