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60-Year-Old Male with Advanced Nonsquamous NSCLC

Joe, a 60-year-old high school teacher, is referred for evaluation of an ongoing cough and shortness of breath. The patient’s X-ray suggests a pulmonary nodule.

The patient has an unremarkable medical history — no hypertension, no history of heart disease, no weight loss, diabetes, or respiratory illness. A full set of laboratory studies, including CBC, liver, and kidney function, are normal.

A CT scan of his chest, abdomen, and pelvis showed a 4 cm mass in the upper left lobe, mediastinal and hilar lymphadenopathy, and an osteolytic lesion of the T4 vertebrae.

To help confirm a diagnosis, a PET/CT study was ordered — it revealed SUV uptake in the upper left lobe mass, the mediastinal lymph node, and the T4 vertebrae. A brain MRI was negative for metastatic lesions.

Needle biopsy of the lung mass revealed poorly differentiated adenocarcinoma. Tissue testing revealed cytokeratin 7 positive, cytokeratin 20 negative, ALK-negative, and the KRAS G12C mutation.

Is pemetrexed/carboplatin/bevacizumab the best treatment option for Joe? Why or why not?

Would enrolling Joe in a clinical trial utilizing a KRAS G12C inhibitor be another option for Joe? Why or why not?