EGFR status was positive in the patient's lymph node specimens. The risks and benefits of first line chemoradiotherapy versus biomarker-driven therapy were discussed with the patient. Considering his poor lung function, poor performance status, and risk for treatment-related pulmonary toxicity, a shared decision was made to begin treatment with an EGFR TKI.Three months later, a repeat chest CT scan showed decrease in size of the right upper lobe mass and a small interlobar lymph node at station 11R superior, but no mediastinal or other hilar adenopathy. A total of six months after initiation of EGFR TKI therapy, another chest CT scan showed an increase in size of the right upper lobe mass and a small increase in the size of the 11R superior adenopathy. The patient is discussed again in the multidisciplinary lung cancer conference.