Molecular Markers and Targeted Therapies in the Management of Non-Small Cell Lung Cancer

Viola W. Zhu, MD, PhD

Assistant Clinical Professor of Medicine, Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, University of California, Irvine School of Medicine, Orange, CA; and Hematology/Oncology Section, VA Long Beach Healthcare System, Long Beach, CA

Sai-Hong Ignatius Ou, MD, PhD

Clinical Professor of Medicine, Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, University of California, Irvine School of Medicine, Orange, CA

Question 6

Questions 6 and 7 refer to the following case:

A 58-year-old Hispanic man who is a nonsmoker presents to the emergency room for shortness of breath and left-sided shoulder pain for several months. A computed tomography (CT) scan of the chest with contrast shows a large pleural effusion and multiple pleural nodular masses up to 3.5 cm. He undergoes diagnostic bronchoscopy and left-sided video-assisted thoracoscopic surgery, drainage of the pleural effusion, and placement of a tunneled pleural catheter. Pathology from the pleural mass biopsy reveals adenocarcinoma of lung primary. Comprehensive molecular profiling shows EGFR L858R mutation. Staging workup including positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) of the brain with and without contrast does not show any distant metastases.

Which of the following would be the most appropriate next step?

  •   PDL-1 testing on biopsied specimen
  •   Consult radiation oncology
  •   Initiate elotinib or gefitinib
  •   Initiate platinum doublet chemotherapy
  •   Initiate crizotinib

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