NSCLC with pleural metastases: Anyone on osimertnib?
Metastatic Non-Small Cell lung Carcinoma (Adenocarcinoma), Right Upper Lobe (TTF-1 positive, P40 negative) with pleural metastases (M1a, Stage IVA)
HISTORY OF PRESENT ILLNESS
68-year-old female, known case of hypertension for the last 2 years, initially presented with fever & cough. evaluation of a right lung lesion detected on imaging. CT chest dated 22/05/2026 revealed a 36 x 31 mm soft tissue lesion in the right upper lobe with adjacent stranding and an additional 10 x 6.6 mm soft tissue lesion in the lateral segment of the right middle lobe, suspicious for malignancy. Subsequent PET-CT dated 02/06/2026 demonstrated a hypermetabolic heterogeneously enhancing soft tissue mass in the right upper lobe bulging into the right oblique fissure, with few metabolically indeterminate nodules along the fissure and a metabolically active right upper paratracheal lymph node suspicious for involvement, with no evidence of distant extrathoracic metastases. CT-guided biopsy of the right lung lesion on 08/06/2026 revealed Non-Small Cell Carcinoma, Adenocarcinoma. Immunohistochemistry showed TTF-1 positivity and p40 negativity, consistent with primary lung adenocarcinoma. CEMRI brain-- age related atrophy, no mets diagnostic thoracoscopy done found to have multiple pleural deposits Further staging with frozen section and biopsy of DIAPHRAGMATIC parietal pleural deposits on 17/06/2026 confirmed metastatic involvernent by adenocarcinoma, establishing Stage IVA (M1a) disease. The patlient was initiated on weekly Paclitaxel (Nanoxel) 100 mg and Carboplatin 150 mg on 18/06/2026 for 9 weeks and subsequently received Cycle 1 Day 8 chernotherapy on 26/06/2026, which was tolerated well without major complications. Next chemotherapy is scheduled for 3/07/2026.
The report of PDL1 Test and lung panel NGS has arrived and has been advised Paclitaxel (Nanoxel) 100 mg and Carboplatin 150 mg with OSIMERTINIB 80 mg once daily for 3 months by Dr.A but Dr. B disagrees and he says that we should not combine Paclitaxel (Nanoxel) 100 mg and Carboplatin 150 mg with OSIMERTINIB 80 and we should complete the chemo then we should conduct the pet ct after that if possible radiation and then targeted medicine. He also said that osimertnib 80 can be combined with platinum-pemetrexed.
Please give advice as we have not started with osimertnib 80, so how we should proceed....
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@kedim Thank you, my scans are good again, NED! I praise God and my oncologists!🙏😁❤️ 2 years on Tagrisso!
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