Case 1097 a Man in his 60'S with a History of Metastatic Lung Adenocarcinoma

The UPMC Department of Pathology offers FREE continuing medical education (CME). Certificates and transcripts can be obtained at no charge through the University of Pittsburgh. The CME modules cover a broad range of topics relevant to pathologists and are presented as case reviews and lectures.  While completing your CME requirements, consider the expertise of our faculty in helping you solve difficult clinical problems. 

Topic for this Session:  Review knowledge gaps with regard to the understanding of metastatic lung cancer.

Target Audience

Physicians and other health care professionals.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Explain the application of molecular testing and treatment options in pulmonary adenocarcinoma.
  • Discuss the transformation of one type of carcinoma to another

Suggested Additional Reading:

  • Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2019), National Cancer Institute, DCCPS, Surveillance Research Program, released April 2021. Underlying mortality data provided by NCHS (
  • Cibas, Edmund S and Ducatman, Barbara S. Cytology : diagnostic principles and clinical correlates. Philadelphia, PA : Elsevier/Saunders, [2014]. National Comprehensive Cancer Network. NCCN Guidelines Version 3.2022; Non-Small Cell Lung Cancer. Date: 2022 (15 April 2022, date last accessed).
  • WHO Classification of Tumours Editorial Board. Thoracic tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2021 [cited 2022 Apr 15]. (WHO classification of tumours series, 5th ed.; vol. 5). Available from:
  • Rosell R, et al. Erlotinib versus standard chemotherapy as first line treatment for European patients with advanced EGFR mutation positive non small cell lung cancer (EURTAC): a multicentre, open label, randomised phase 3 trial. Lancet Oncol 2012;13:239-246.
  • Planchard D, et al. Dabrafenib plus trametinib in patients with previously untreated BRAF(V600E)-mutant metastatic non-small-cell lung cancer: an open-label, phase 2 trial. Lancet Oncol 2017;18:1307-1316.
  • Skoulidis F, et al. Sotorasib for lung cancers with KRAS p.G12C mutation. N Engl J Med 2021;384:2371-2381. Wolf J, et al; GEOMETRY mono-1 Investigators. Capmatinib in MET exon 14-mutated or MET-amplified non-small-cell lung cancer. N Engl J Med 2020;383:944-957.
  • Drilon A, et al. Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med 2018;378:731-739.
  • Soria JC, et al. Osimertinib in untreated EGFR-mutated advanced non-small cell lung cancer. N Engl J Med 2018;378:113-125.
  • Cho JH, et al. Osimertinib for patients with non-small-cell lung cancer harboring uncommon EGFR mutations: a multicenter, open-label, phase II trial (KCSGLU15-09). J Clin Oncol. 2020;38:488-495
  • Sequist LV, Waltman BA, Dias-Santagata D, Digumarthy S, Turke AB, Fidias P, Bergethon K, Shaw AT, Gettinger S, Cosper AK, Akhavanfard S, Heist RS, Temel J, Christensen JG, Wain JC, Lynch TJ, Vernovsky K, Mark EJ, Lanuti M, Iafrate AJ, Mino-Kenudson M, Engelman JA. Genotypic and histological evolution of lung cancers acquiring resistance to EGFR inhibitors. Sci Transl Med. 2011 Mar 23;3(75):75ra26. doi: 10.1126/scitranslmed.3002003. PMID: 21430269; PMCID: PMC3132801.
  • Piotrowska Z, Isozaki H, Lennerz JK, Gainor?JF, Lennes?IT, Zhu?VW, et al Landscape of acquired resistance to osimertinib in EGFR-mutant NSCLC and clinical validation of combined EGFR and RET inhibition with osimertinib and BLU-667 for acquired RET fusion. Cancer Discov?2018;8:1529-39.
  • Mehlman C, Cadranel J, Rousseau-Bussac G, Lacave R, Pujals A, Girard N, et al Resistance mechanisms to osimertinib in EGFR-mutated advanced non-small-cell lung cancer: a multicentric retrospective French study. Lung Cancer?2019;137:149-56.
  • Marcoux N, Gettinger SN, O'Kane G, Arbour KC, Neal JW, Husain H, Evans TL, Brahmer JR, Muzikansky A, Bonomi PD, Del Prete S, Wurtz A, Farago AF, Dias-Santagata D, Mino-Kenudson M, Reckamp KL, Yu HA, Wakelee HA, Shepherd FA, Piotrowska Z, Sequist LV. EGFR-Mutant Adenocarcinomas That Transform to Small-Cell Lung Cancer and Other Neuroendocrine Carcinomas: Clinical Outcomes. J Clin Oncol. 2019 Feb 1;37(4):278-285. doi: 10.1200/JCO.18.01585. Epub 2018 Dec 14. PMID: 30550363; PMCID: PMC7001776.
  • Offin M, Chan JM, Tenet M, Rizvi HA, Shen R, Riely GJ, Rekhtman N, Daneshbod Y, Quintanal-Villalonga A, Penson A, Hellmann MD, Arcila ME, Ladanyi M, Pe'er D, Kris MG, Rudin CM, Yu HA. Concurrent RB1 and TP53 Alterations Define a Subset of EGFR-Mutant Lung Cancers at risk for Histologic Transformation and Inferior Clinical Outcomes. J Thorac Oncol. 2019 Oct;14(10):1784-1793. doi: 10.1016/j.jtho.2019.06.002. Epub 2019 Jun 19. PMID: 31228622; PMCID: PMC6764905.
Course summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 0.50 Attendance
Course opens: 
Course expires: 

Course Director and Planning Committee:

Karen E Schoedel, MD - Professor of Pathology, Member of the Division of Anatomic Pathology, University of Pittsburgh

Course Directors:
Gabriel Sica, MD, PhD - Fellowship Program Director, University of Pittsburgh Medical Center, Department of Pathology

Conflict of Interest Disclosure:

No planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.


In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician (CME)

The University of Pittsburgh School designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Other Healthcare Professionals

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Disclaimer Statement:

The information presented at this activity represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

Available Credit

  • 0.50 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 0.50 Attendance
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