Case Presentation: Navigating Treatment Decisions in EGFR-Mutated NSCLC With Central Nervous System Involvement
Patient Case:
A patient in her mid-60s presented with a primary complaint of cough, accompanied by an approximately 10-pound weight loss and decreased appetite. She also reported tinnitus that was more pronounced on the left, memory difficulties, and a sense of disequilibrium.
Chest radiography raised concern for multifocal pneumonia, although malignancy remained in the differential diagnosis. Subsequent CT imaging revealed multiple pulmonary nodules, the largest measuring nearly 4 cm. Biopsy confirmed lung adenocarcinoma, and molecular testing identified an EGFR L858R mutation.
Brain MRI demonstrated multiple sub centimeter enhancing foci consistent with brain metastases. In Additional areas of sulcal enhancement in the posterior fossa raised concern for leptomeningeal disease.
