Case 2: Angela, 55 years old

Angela, a 55-year-old medical secretary, loves hiking to desolate places, even in bad wetter conditions. During a walk in the Belgian Ardennes, she fell from a slippery small bridge while crossing a stream. Because of chest pain, an X-ray was made, showing no rib lesions but a large opacity in the left lung. Based on further investigations, she was diagnosed with stage IV lung adenocarcinoma harboring an EGFR exon 19 deletion mutation. She was treated with osimertinib, resulting in an almost complete response. After 25 months, she developed symptomatic progressive disease.

• Medical history: surgery for bone fracture left leg; never-smoker
• ECOG PS: 1
• CEA: 128 ng/ml
• No symptoms from her lung cancer
• Previous biopsy at diagnosis: lung adenocarcinoma, PD-L1 80%, EGFR exon 19 deletion upon NGS testing
• CT findings: regrowth of the primary tumor and associated adenopathy. Multiple lever and left adrenal metastases? No brain metastases