Newly Diagnosed EGFR Exon 19 Deletion NSCLC With Brain Metastases

Wade Iams, MD, MSCI, of Tennessee Oncology, presents the first clinical scenario in this OncLive My Treatment Approach discussion with Edgardo Santos, MD, FACP, FASCO, of Starling Oncology: a 58-year-old woman who never smoked, with a 6-week history of progressive cough. Computed tomography shows a 4.1-cm left upper lobe mass, mediastinal lymphadenopathy, bilateral sub-centimeter nodules, and a small left pleural effusion. Positron emission tomography confirms activity in the primary tumor and mediastinal nodes, plus a solitary L3 vertebral lesion. Brain magnetic resonance imaging shows 2 small asymptomatic lesions, 5 mm and 7 mm, without edema and with no immediate indication for local therapy. Biopsy shows adenocarcinoma with an EGFR exon 19 deletion. Baseline laboratory values are normal, with no bleeding or thrombosis history. This is stage IVB disease with a performance status of 1. She works part-time, lives 45 minutes from the infusion center, and wants to keep working.