Clinical Case: EGFR-Mutant (Exon 19 del) Advanced NSCLC
Panelists discuss how a 46-year-old graphic designer with stage IV EGFR-mutant non–small cell lung cancer and brain metastases was successfully treated with amivantamab plus lazertinib after weighing multiple frontline treatment options.
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This segment introduces a comprehensive case study of a 46-year-old graphic designer diagnosed with stage IV non–small cell lung cancer (NSCLC) harboring an EGFR exon 19 deletion. The patient presented with classic symptoms including persistent dry cough, blurred vision, headaches, and fatigue, initially attributed to work stress and environmental factors. Advanced imaging revealed a 3.6-cm left upper lobe mass, mediastinal lymphadenopathy up to 1.4 cm, and 2 small brain metastases under 1 cm.
The diagnostic workup confirmed lung adenocarcinoma through biopsy, with next-generation sequencing revealing both EGFR exon 19 deletion and TP53 co-mutation. This molecular profile represents a high-risk subset of EGFR-mutant NSCLC patients who may benefit from more aggressive frontline treatment approaches. The patient's excellent performance status, strong family support system, and absence of smoking history made her an ideal candidate for combination targeted therapy.
Treatment decision-making involved careful consideration of multiple frontline options, including osimertinib monotherapy, osimertinib plus chemotherapy, and amivantamab plus lazertinib combination. After thorough discussion weighing risks and benefits, the patient chose amivantamab plus lazertinib with appropriate prophylactic measures including dexamethasone premedication and enhanced dermatologic management protocols. The case demonstrates the importance of shared decision-making in modern precision oncology, with the patient successfully returning to work and yoga practice after managing initial treatment-related fatigue through supportive care measures.
