Post-test Question #1:
Patricia is a 58-year-old female former smoker (5 pack-year). She presents with new-onset shortness of breath. Her ECOG performance status is 1. A chest X-ray shows large right sided pleural effusion. A chest CT shows a right upper lobe mass with associated ipsilateral hilar and paratracheal adenopathy and large ipsilateral pleural effusion. Pleural fluid cytology shows adenocarcinoma cells, TTF1+, and p40 –. PET/CT demonstrates metastases to the liver and bone. MRI of the brain with/without contrast shows no brain metastases.
Post-test Question #2:
Pauline is a 38-year-old female recently diagnosed with NSCLC harboring an EGFR exon 19 deletion. Brain MRI shows 7 brain metastases; the largest is 1.8 cm; the brainstem is not involved, and there is minimal vasogenic edema.
Post-test Question #3:
James is a 55-year-old male with stage IV NSCLC (adenocarcinoma, PD-L1 TPS=80%, harboring an EGFR exon 19 deletion) treated with osimertinib for the past 18 months. He has an ECOG performance score of 0 and has tolerated treatment well with no side effects. He was last seen 3 months ago when he presented with worsening bone pain and weight loss. An MRI of the brain revealed no evidence of CNS metastases. CT C/A/P with contrast reveals liver and bone metastases; a biopsy of the liver lesion reveals adenocarcinoma with high level MET amplification (MET/CEP7 ratio = 10).
Post-test Question #4:
Donald is a 71-year-old former heavy smoker who presents with worsening shortness of breath. He is found to have lung adenocarcinoma also involving the lymph nodes, bone, and liver. Molecular testing revealed an EGFR exon 20 insertion mutation.