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63-Year-Old Female with Vision Disturbances and Headaches

Evelyn, who is 63, presents to her primary care physician, complaining of headaches, visual disturbances, and fatigue. Her medical history includes hypertension and hyperlipidemia, both under control with medication. She is a former smoker with a 40-pack year history.

Her physical exam is relatively unremarkable, except for decreased breath sounds at the right lower lung base. Her blood chemistries and CBC are within normal range.

Brain imaging reveals a 1.1 cm parietal mass. CT chest, abdomen, and pelvis demonstrates a 3.3 cm mass in her right lower lobe and three small masses in her liver. A CT-guided biopsy of the lung nodule shows a grade 2 adenocarcinoma of the acinar subtype. Her ECOG score is 1.

Her 22C3 test shows that she has a 70% expression of PD-L1. Although the patient is anxious to begin treatment, her treatment team insists on molecular testing before developing a treatment plan. Results reveal the KRAS G12C mutation.

Knowing the presence of the KRAS mutation, would you initiate immunotherapy?
Would you consider recommending Evelyn enroll in a clinical trial investigating KRAS G12C inhibitors?