Virtual Molecular Tumor Board

Carolinas HealthCare System
Levine Cancer Institute
Presented by: Dr. Gregory M. Brouse
Patient: Non–small cell lung cancer

Initial Diagnosis

A 76-year-old female former smoker presented with cough, leading her to undergo a chest X-ray, which showed a right upper lobe mass. The patient smoked 2.5 packs per day for 15 years and quit smoking more than 40 years earlier.

• August 2016: CT imaging of chest identified a large mass in the right suprahilar and peritracheal regions.
• August 2016: Endobronchial ultrasound biopsy on level IV lymph node was performed.
• Non–small cell lung cancer (poorly differentiated adenocarcinoma; TTF-1 and CK7 immunostains were positive)
• Molecular analysis was performed in house.
• EGFR L858R mutated (detected with Roche cobas EGFR Mutation Test v2 – tumor tissue)
• ALK wild-type
• August 2016: PET scan showed extrathoracic disease (right hilar and bilateral mediastinal lymph nodes, left adrenal gland, right hip bone metastases).
• August 2016 – September 2016: Palliative radiation therapy to right hip/sacrum (30 Gy in 10 fractions)
• August 2016: Initiated treatment on randomized clinical trial (erlotinib [Tarceva; Genentech, Astellas] +/- VEGF inhibitor)
• Typical EGFR rash on face (treated with topical hydrocortisone then prednisone 10 mg), loose stools