Patient Case Presentation: A 45-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Liver Metastases

EP: 1.The Evolution of EGFR-Mutated Advanced NSCLC Treatment: Present Considerations and Future Treatment Options

EP: 2.Has Combination Therapy Become the New Frontline Treatment Standard for EGFR-Mutant Metastatic NSCLC?

EP: 3.Decision Points to Consider When Choosing Treatment With Monotherapy or Combination Therapy for EGFR-Mutant mNSCLC

EP: 4.Evaluating Patient Preferences for the Treatment of EGFR-Mutant mNSCLC

EP: 5.Comparing the Combination Therapies for the Treatment of EGFR-Mutant mNSCLC

EP: 6.Considering Resistance Mechanisms When Choosing Therapy in the Frontline Setting

EP: 7.The Importance of Maintaining Quality of Life and Intervening Early When Adverse Events Occur in the Frontline Treatment Setting

EP: 8.Weighing the 1-Year Projected Overall Survival Benefit With MARIPOSA in the Frontline Treatment of EGFR-Mutant mNSCLC

EP: 9.Discussing the Time and Financial Toxicities Associated With Combination Therapies and Potential Mitigation Strategies

EP: 10.Discussing Potential Combination Therapy Medication-Associated Toxicities With Patients

EP: 11.Evaluating the Clinical Utility of Subcutaneous Amivantamab in the Treatment of EGFR-Mutant mNSCLC

EP: 12.The Importance of Multidisciplinary Collaboration With Subspecialty Physicians in the Toxicity Management With Treatment

EP: 13.Exploring Second-Line Treatment Options Including Targeted Radiation and Surgery for the Management of EGFR-Mutant mNSCLC

EP: 14.Tissue vs Plasma Biopsy After First Disease Progression in EGFR-Mutant NSCLC

EP: 15.Deciding Between a Biomarker-Directed Approach and a Biomarker-Agnostic Approach for Second-Line Treatment of EGFR-Mutant NSCLC

EP: 16.Continuing the Targeted TKI in the Second Line for the Treatment of EGFR-Mutant NSCLC

EP: 17.When to Consider Retreatment With Chemotherapy After FLAURA2 for EGFR-Mutant NSCLC

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EP: 18.Patient Case Presentation: A 45-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Liver Metastases

EP: 19.Patient Case Presentation: A 69-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Symptomatic Brain Metastases

This segment presents a case of a 45-year-old Caucasian male marathon runner and rock climber with newly diagnosed EGFR-mutant (exon 19 deletion) stage 4B metastatic non–small cell lung cancer (mNSCLC). The patient has numerous small liver metastases, excellent performance status (ECOG 0), and negative brain MRI. Critically, he travels frequently for work and serves as the sole source of income and medical insurance for his family, creating significant practical considerations for treatment selection. The case highlights the complex balance between treatment efficacy and quality of life factors, particularly regarding treatment convenience and ability to maintain employment.

The treatment discussion reveals differing approaches based on patient-specific factors. While combination therapies offer progression-free survival benefits, the patient’s work demands and financial responsibilities may favor single-agent osimertinib due to its oral convenience and reduced time toxicity. Some clinicians lean toward combination therapy given the patient’s young age and excellent performance status, suggesting more aggressive up-front treatment to maximize progression-free survival benefits. Creative scheduling strategies, such as Friday infusions before weekends, are proposed to minimize work disruption. The availability of subcutaneous amivantamab could potentially change treatment preferences by reducing infusion time burdens.

The presence of TP53 comutations adds prognostic complexity, representing a poor prognostic marker associated with more aggressive disease biology. While this finding might push toward more aggressive frontline combination therapy, the optimal approach for comutations remains unclear. For second-line treatment scenarios involving MET overexpression (IHC 2+ or 3+), targeted options include oral MET inhibitors like tepotinib, capmatinib, or savolitinib, which offer convenience advantages over intravenous therapies. Clinical trial participation remains the preferred option when available. The case emphasizes the need for personalized treatment approaches that consider not only disease biology but also individual patient circumstances, financial constraints, and quality of life priorities in treatment decision-making.