C80-20 Mind Over Metastasis: A Rare Case of Disease Control Without Chemotherapy

Abstract Brain metastases are a common and devastating complication of non-small cell lung cancer (NSCLC), occurring in nearly 20% of patients at diagnosis. Historically, the presence of brain metastases has signified advanced, incurable disease with median survival of less than a year, even with chemotherapy and whole-brain radiotherapy. However, the emergence of targeted immunotherapy has transformed care, resulting in higher survival rates for those patients with positive driving mutations. This case report highlights a patient with stage IV lung adenocarcinoma with brain metastasis who achieved 5 years remission with combined surgical resection and targeted immunotherapy in the absence of systemic chemotherapy. A 63-year-old female with tobacco use history and no known personal or family history of malignancy presented for evaluation of dyspnea on exertion and cough. CT chest showed a right upper lobe (RUL) mass, and navigational bronchoscopy with endobronchial ultrasound (EBUS) confirmed adenocarcinoma stage IV, T2, N3, M1. Worsening headache and confusion prompted a CT head which showed a large left parietal mass with ring enhancement. PET scan showed RUL cancer with extensive metastatic adenopathy involving the supraclavicular region, mediastinum, and bilateral lung hila. Given her disease burden and PDL1 90%, single agent immunotherapy in combination with resection was deemed appropriate, and neurosurgery performed a craniotomy with excision of a single left parietal metastatic tumor. Consolidative radiation was performed on the resected region, and the patient was started on Keytruda immunotherapy. Genetic testing revealed MET amplification, demonstrating Crizotinib sensitivity which was started and the patient remains on today. Early repeat scans demonstrated stable pulmonary disease with no clinical or radiographic evidence of recurrence or metastasis. However, CT chest later showed interval increase in RUL mass. Given high risk of recurrence and RUL mass progression, a repeat bronchoscopy with EBUS-guided biopsy was performed which showed no evidence of active disease. This case highlights a unique outcome of complete, maintained remission of stage IV NSCLC with brain metastasis managed with craniotomy, radiation, and immunotherapy, notably without systemic chemotherapy. The importance of molecular testing cannot be understated, as it is the primary driver of precision-based treatment. This highlights a fundamental shift in the management of brain metastasis in lung cancer with targeted treatments guided by genetic testing and biomarkers as opposed to systemic chemotherapy and radiation. As personalized treatment continues to progress, advanced NSCLC is evolving from a terminal diagnosis to an increasingly treatable disease. This abstract is funded by: none