May 2, 2025
Main Discussion Topics: Management of a 56-year-old never-smoker with high-burden metastatic disease, treatment selection process considering multiple high-risk features and response to therapy and subsequent maintenance decisions
Key Points for Physicians: Patient presented with multiple high-risk features: high disease burden, brain metastases, TP53 mutation, liver metastases, FLAURA2 regimen (osimertinib + chemotherapy) was selected due to these factors and patient preference for longevity, toxicity management included osimertinib dose reduction and growth factor support
Notable Insights: After approximately 1 year of therapy with excellent response, the patient elected to discontinue pemetrexed maintenance due to quality-of-life concerns, while continuing osimertinib.
Clinical Significance: This case illustrates the real-world application of risk-stratified treatment selection, toxicity management, and evolving treatment decisions based on response and patient preferences.
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