DR SPIGEL: It’s an interesting gentleman who initially presented to the emergency room. He’s a smoker, actually works in a boat painting factory, presented sick, with advanced disease, and ended up getting systemic therapy. He was so-called pan-wild-type on EGFR, ALK and, actually, ROS testing. He progressed through carboplatin/pemetrexed off study after about 4 months on treatment. And we had a trial of immunotherapy available for him, actually anti-PD-1 therapy.

He went on that and he’s been on that about 2 years.

DR LOVE: Which agent?

DR SPIGEL: So nivolumab. So I’m always nervous every time scans come up, even though he tells me things are going well, about what we’re going to do next. Is he going to go on a trial? So I sent off, actually, comprehensive testing with Foundation Medicine. And one day I’m in clinic with him and on my tabletop is the report that came back from Foundation. And I thought the sales rep had just dropped me off some information material because it was so thick. It turned out this was his report.

And it was about 50 pages. His actual alterations that were discovered took up 2 pages. And I think — Vince Miller tells me we still hold the record for the most mutations ever described in a patient. So he had over 41 alterations seen, including an EGFR.

DR SPIGEL: He’s doing beautifully. He’s doing fantastic on nivolumab therapy, really no issues at all.

DR LOVE: And, again, no toxicity whatsoever?

DR SPIGEL: None. Zero. He’s doing well. And you hope a guy like this will do well for another 2 years, but at some point we expect him to progress.