The patient elected to have biomarker-directed therapy rather than chemoradiation. She was started on EGFR TKI-targeted therapy. She tolerated treatment well except for mild diarrhea and an acne type rash over her neck and face which disappeared after several weeks of treatment. Her follow up PET-CT scans were stable until 12 months later when increased size and activity of the lymphadenopathy was seen in stations 4R, 4L and 11L. She reported intermittent hemoptysis, but remained active and independent in her activities of daily living. She had strong social support and wanted additional therapy. This is discussed at your multidisciplinary lung cancer conference.