Table 2. Timeline of disease administration.
| Dates | Initial and follow-up visits | Diagnostic testing (including dates) | Interventions |
|---|---|---|---|
| Feb 2014 | Physical examination revealed elevated CEA without clinical symptoms | PET/CT: malignant lesions of the dorsal segment of the left lower lung with metastasis of the subcarinal lymph nodes and left ilium (28th February 2014) | 4 cycles of chemotherapy (pemetrexed plus cisplatin); Tarceva 150 mg qd given as maintenance therapy |
| Brain MRI: bilateral frontoparietal ischemic foci (2nd Mar 2014) | |||
| Bronchoscopy: swelling of the mucosa in the dorsal segment of the left lower lung, occlusion of the orifice, biopsy showing adenocarcinoma with EGFR 21 exon L858R mutation (6th March 2014) | |||
| Jun 2016 | The patient complained of asthenia and light cough | CT: local progression in the chest lesion (20th June 2016) | Tarceva treatment in combination with local radiotherapy |
| Dec 2016 | Patient complained of pain in the buttocks and caudal vertebrae | Bone scan: new lesion of pelvic metastasis | Tarceva treatment in combination with sacroiliac joint and ilium radiotherapy |
| Aug 2017 | Patient complained of progressive cough and hip pain | CT scan and bone scan: indicated lung and bone progression again (18th August 2017) | Tarceva treatment stopped, and patient given Tagrisso 80 mg qd |
| Blood NGS test: EGFR 21 exon L858R mutation combined with EGFR 20 exon T790M mutation (25th August 2017) | |||
| Dec 2018 | Patient complained of cough, shortness of breath, and obvious headache with disturbance of consciousness | CT scan: the target lesion of the left lower lung was enlarged, and the pleural effusion had increased (19th December 2018) | Tagrisso dose doubled from 80 mg qd to 160 mg qd |
| Brain MRI: lacunar infarction (25th Dec 2018) | |||
| CSF cytology: adenocarcinoma cells (26th December 2018) | |||
| CSF NGS: EGFR 21 exon L858R mutation combined with EGFR 20 exon T790M mutation (5th January 2019) | |||
| Aug 2019 | Headaches and unconsciousness reoccurred | None | Best support treatment and hospice care |
CEA, carcinoembryonic antigen; CT, computed tomography; CSF, cerebrospinal fluid; EGFR, epidermal growth factor receptor; MRI, magnetic resonance imaging; NGS, next-generation sequencing; PET, positron emission tomography.