Expert Cancer Panel: Newly diagnosed stage IV lung adenocarcinoma, EGFR mutation positive

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Published
Recorded on 3/13/2021

95-year-old women, former smoker (3 pack years) with newly diagnosed stage IV lung adenocarcinoma, EGFR mutation positive, cT4NxM1c

Summary:
- In the setting of brain metastases and known EGFR+ mutation in this 95 year old patient, the decision to pursue initial treatment with a TKI like osimertinib versus radiotherapy would be dependent on the overall burden of disease and the type of mutation.
- Osimertinib is preferred as a first line approach over radiotherapy, particularly whole brain radiation, to reduce morbidity, especially if the mutation is ALK positive as it responds dramatically to TKIs.
- The panel recommends starting osimertinib at the highest dose the patient may tolerate to treat the brain metastases, although eventually dose adjustment is recommended given the patient’s age and functional status as a known side effect is fatigue.
- In the setting of no underlying cardiomyopathy, an echocardiogram is not necessary prior to starting osimertinib.
Repeat imaging should be performed at 6 weeks after starting a TKI to assess for disease response.
- Concurrent chemotherapy is not recommended with osimertinib or other TKIs; if there is disease progression on this therapy, consolidative radiotherapy with SRS is the next step.


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Oncology
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