Afatinib in the Treatment of Advanced Non-Small Cell Lung Cancer with Rare EGFR (in exon 18-T179X) Mutation – a Case Report

Česká verzia

Authors: Čoupková Helena; Vyzula Rostislav
Published in the journal: Klin Onkol 2018; 31(5): 380-383
Category: Case Report
doi: https://doi.org/10.14735/amko2018380

Summary

Introduction:

Exon 18-T719X EGFR mutation in non-small cell lung cancer is rare, only 1–5% of all EGFR mutations. The efficacy of EGFR tyrosin kinase inhibitors in tumours with uncommon mutations is still unclear and the prediction of response of such tumours to therapy remains unexplored.

Case:

A 71-year-old woman with no previous smoking history with disseminated lung adenocarcinoma with exon 18-T719X EGFR mutation was treated with afatinib. A partial response was achieved in 2 months, progression-free survival was 19 months. The dose of afatinib was reduced to 30 mg/day after 3 months due to skin toxicity and stomatitis grade 2. Next reduction to 20 mg/day was performed after 10 subsequent months due to leucopenia and neutropenia grade 2.

Conclusion:

With this patient, a partial response which lasted 19 months despite 50% reduction of the afatinib dose was achieved.

Key words:

afatinib – non-small cell lung cancer – epidermal growth factor-mutation receptor – treatment outcome – drug toxicity

This article was supported by Boehringer Ingelheim.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted: 27. 9. 2018

Accepted: 1. 10. 2018

Zdroje

1. Svoboda M, Fabian P, Slabý O et al. Cílená léčba bronchioloalveolárního plicního adenokarcinomu inhibitory tyrozinkinázové aktivity EGFR: kazuistika klinicky promptní a výrazné odpovědi a přehled literatury. Klin Onkol 2010; 23 (4): 224–230.

2. Sequist LV, Bell DW, Lynch TJ et al. Molecular predictors of response to epidermal growth factor receptor antagonists in non-small-cell lung cancer. J Clin Oncol 2007; 25 (5): 587–595. doi: 10.1200/JCO.2006.07.3585.

3. Fiala O, Šatánková M, Kultan J et al. Výskyt mutací genu EGFR u pacientů s NSCLC v České republice. Onkologie 2014; 8 (4): 156–159.

4. Wu JY, Yu CJ, Chang YC et al. Effectiveness of tyrosine kinase inhibitors on „uncommon“ epidermal growth factor receptor mutations of unknown clinical significance in non–small cell lung cancer. Clin Cancer Res 2011; 17 (11): 3812–3821. doi: 10.1158/1078-0432.CCR-10-3408.

5. Kobayashi Y, Togashi Y, Yatabe Y et al. EGFR exon 18 mutations in lung cancer: molecular predictors of augmented sensitivity to afatinib or neratinib as compared with first-or third-generation TKIs. Clin Cancer Res 2015; 21 (23): 5305–5313. doi: 10.1158/1078-0432.CCR-15-1046.

6. Sukl.cz. [online]. Státní ústav pro kontrolu léčiv. Souhrn údajů o přípravku afatinib. Dostupné z: http: //www.sukl.cz.

7. Yang JC, Sequist LV, Geater SL et al. Clinical activity of afatinib in patients with advanced non-small-cell lung cancer harbouring uncommon EGFR mutations: a combined post-hoc analysis of LUX-Lung 2, LUX-Lung 3, and LUX-Lung 6. Lancet Oncol 2015; 16 (7): 830–838. doi: 10.1016/S1470-2045 (15) 00026-1.

8. Sequist LV, Yang JC, Yamamoto N et al. Phase III study of afatinib of cisplatin plus pemetrexed in patients witha metastatic lung adenocarcinoma with EGFR mutations, J Clin Oncol 2013; 31 (27): 3327–3334. doi: 10.1200/JCO.2012.44.2806.