Case Study: Individualizing Frontline Therapy in an Older Patient With Comorbidities and Limited Support

This segment presents a contrasting case: an older patient with a classic sensitizing mutation, lower disease burden, no central nervous system involvement, reduced renal function, a prior thromboembolic event, and meaningful access and support constraints. The faculty use this scenario to illustrate where single-agent therapy remains a sound, guideline-supported choice, driven by the absence of high-risk features and the patient's circumstances and preferences. Importantly, they caution against ruling out combinations reflexively: a prior clot is not an absolute barrier given existing anticoagulation, and reduced renal function calls for careful dosing rather than automatic exclusion. The discussion emphasizes that social support should inform, not dictate, the medical decision, and that resources such as social work can help. Faculty also raise local consolidation as a tailored escalation option and outline the lighter monitoring cadence that makes monotherapy attractive for a patient who values independence.