Phys Vivas · respiratory
Lung Cancer — Viva Defence
Structured DCE viva for lung cancer: long-case defence of a never-smoker with stage IV EGFR-mutant NSCLC — targeted-therapy sequencing, resistance management, and the conversations that evolve as options narrow.
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Opening statement (SASPOP, delivered aloud)
"Ms Tran is a 52-year-old never-smoker with stage IV EGFR-mutant lung adenocarcinoma, eighteen months into an excellent response to first-line osimertinib, now with radiological progression in bone and liver while remaining clinically well. Her main problems are: acquired resistance to her targeted therapy; a limited metastatic burden with one new site that may represent oligoprogression; symptom control that remains good but will not stay that way without a plan; and the psychological whiplash of progression after a long good run. I would like to characterise her resistance mechanism with re-biopsy, decide between local therapy for oligoprogression and a systemic switch, and recalibrate her goals-of-care conversation to the new phase of her illness." [1]
References4ShowHide
- [1]Soria JC, Ohe Y, Vansteenkiste J, et al. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer N Engl J Med, 2018.PMID 29151359
- [2]Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma N Engl J Med, 2009.PMID 19692680
- [3]Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med, 2010.PMID 20818875
- [4]Nicholson AG, Scagliotti G, Tsao MS, et al. 2021 WHO Classification of Lung Cancer: A Globally Applicable and Molecular Biomarker-Relevant Classification J Thorac Oncol, 2022.PMID 36031295