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63-Year-Old Female with Headaches and Visual Disturbances

A 63-year-old Caucasian female presented with headaches, visual problems, nausea, and fatigue. She has hyperlipemia and hypertension; both controlled with medication. Otherwise, her medical history is unremarkable, and she is a non-smoker. Her blood pressure is 145/75. Her BMI is 24.7, and her ECOG status is 1. Her CBC is in normal limits.

A brain MRI shows a left parietal mass at the gray-white junction with vasogenic edema. CT scans of the chest, abdomen, and pelvis revealed a 3.6 cm mass in the right lower lobe and several small lesions in the liver.
The biopsy of the mass revealed a grade 2 adenocarcinoma. PD-L1 testing showed a 25% expression. Next-generation sequencing was positive for the KRAS G12C mutation. The patient showed no ALK mutations.

Is Immunotherapy, with or without chemotherapy, this patient’s best option? Why or why not?

Given the metastatic burden of this patient’s disease, would you recommend a clinical trial utilizing KRAS Oncogene therapy targeting the KRAS G12C mutation? Why or why not?