2023 World Conference on Lung Cancer (Posters)-EP08.02. A Case of Persistent Complete Response To Personalized Osimertinib and Concurrent Chemoradiation for Stage IIIC EGFRm NSCLC

EP08.02. A Case of Persistent Complete Response To Personalized Osimertinib and Concurrent Chemoradiation for Stage IIIC EGFRm NSCLC - PDF(Slides)

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This case report describes the management and clinical outcomes of a patient with stage IIIC unresectable EGFR-mutant (EGFRm) non-small cell lung cancer (NSCLC). The patient received personalized treatment with osimertinib as induction therapy, followed by radical concurrent chemoradiation therapy (cCRT) and maintenance osimertinib. The treatment approach aimed to achieve a curative outcome in a patient who was medically fit and willing to pursue aggressive treatment.<br /><br />The patient initially presented with symptoms of hemoptysis and exertional dyspnea. Imaging confirmed the presence of a hypermetabolic lung mass and multiple regional nodal metastases. The patient underwent bronchoscopy, which revealed an adenocarcinoma with an EGFR exon 19 deletion. No central nervous system metastases were detected.<br /><br />The treatment plan included the initiation of osimertinib as induction therapy. If significant tumor shrinkage was achieved, subsequent radical chemoradiation was considered. The patient received cCRT with intensity-modulated radiation therapy (IMRT) and weekly paclitaxel/carboplatin for 7 weeks. Osimertinib was withheld for 2 days before chemoradiation and resumed 2 weeks after completion.<br /><br />Follow-up PET/CT scans showed a dramatic reduction in the size and metabolic activity of the primary tumor and all regional nodes. The patient maintained a complete metabolic response in the nodes. Post-chemoradiation, the patient experienced only grade 1 pneumonitis, and no osimertinib-related pneumonitis or other adverse events were noted.<br /><br />The case report emphasizes the importance of close monitoring of tumor response and potential signs of lung toxicity during and after osimertinib therapy. This personalized treatment approach, combining induction osimertinib, radical cCRT, and maintenance osimertinib, resulted in persistent complete anatomic and metabolic response in the patient. The safety and efficacy of maintenance osimertinib after chemoradiation therapy for unresectable stage III NSCLC are being further investigated in an ongoing trial.<br /><br />The report concludes that personalized treatment approaches can be considered for medically fit stage IIIC EGFRm patients who are willing to pursue more aggressive and potentially curative treatments.

Asset Subtitle

Victor Ho Fun Lee

Meta Tag

Speaker Victor Ho Fun Lee

Topic Local-Regional NSCLC: Multimodality Therapy

Keywords

unresectable EGFR-mutant NSCLC

osimertinib

induction therapy

radical chemoradiation

maintenance osimertinib

tumor response

lung toxicity

metabolic response

pneumonitis

curative treatments