52-Year-Old Patient With Lung Adenocarcinoma and HER2 Overexpression Partnership Page
Patient Case:
Patient is a 52-year-old male with hypertension and former tobacco use with a history of 30 pack-years who presented with 3 months of cough and progressive shortness of breath. CT scans showed a 3.2 cm right upper lobe pulmonary mass, multiple bilateral pulmonary nodules, a moderate right pleural effusion, and multiple liver nodules concerning for metastasis. MRI brain was negative for central nervous system (CNS) metastasis. PET scan confirmed FDG avidity in the lesions noted on his CT scans. Biopsy of a liver nodule demonstrated lung adenocarcinoma with immunohistochemistry (IHC) positive for TTF1 and Napsin A staining. Molecular testing of his liver biopsy demonstrated no actionable mutations and PD-L1 TPS 10%.
Patient was treated with the combination of carboplatin, pemetrexed, and pembrolizumab for 4 cycles, followed by pemetrexed and pembrolizumab maintenance. He had a partial response to initial therapy.
However, after 10 months on treatment CT scans demonstrated new and enlarging liver nodules. Additional IHC testing on his initial liver biopsy showed no c-Met overexpression and HER2 IHC 3+.
