Case Presentation: Individualizing Treatment for Stage III KRAS G12C–Mutated Non–Small Cell Lung Cancer
Patient Case:
A 65-year-old woman with a 40-year smoking history (5 cigarettes/day; quit 9 years earlier) presented with a 7-month history of persistent cough following influenza and COVID-19 infection, progressive dyspnea, and unintentional weight loss. Chest radiography followed by contrast-enhanced CT identified a right middle lobe lung lesion. CT-guided biopsy demonstrated poorly differentiated, predominantly necrotic pulmonary adenocarcinoma, with tumor cells positive for TTF-1, Napsin A, and CK7 and negative for p63, p40, and GATA3.
Brain MRI showed no evidence of intracranial metastases. PET/CT revealed the primary right middle lobe tumor with extensive mediastinal, right hilar, and bilateral supraclavicular lymphadenopathy. Because of the interval between imaging and oncology evaluation, repeat CT confirmed no distant metastatic progression, and the patient was staged as T4N3M0 (stage IIIC) according to the AJCC 9th edition.
Repeat biopsy of a supraclavicular lymph node confirmed lung adenocarcinoma with PD-L1 expression of 98%. Liquid biopsy identified KRAS G12C and TP53 mutations. Her medical history was notable for irritable bowel syndrome, and family history included colon cancer in her mother and prostate cancer in her brother. Laboratory evaluation showed mild normocytic anemia with otherwise normal renal and hepatic function.
