Small Cell Lung Cancer With Unusual Colon Metastases After Afatinib

What happened, in summary

A 65-year-old woman came to emergency care on June 28, 2015 after 3 to 4 months of worsening shortness of breath. A biopsy of a left lower-lung tumor confirmed small cell lung cancer. Imaging showed that the disease had already spread to the liver, adrenal glands, bones, and brain. She declined chemotherapy and brain radiotherapy and was lost to follow-up.

She returned about 3 months later with increasing chest discomfort and further progression. Testing of the tumor found an EGFR exon 19 deletion. Because she would accept only oral treatment, she began afatinib on September 23, 2015. Follow-up imaging showed a partial response, with shrinkage of the lung tumor, regional lymph nodes, liver and adrenal lesions, bone disease, and brain metastases.

By April 2016, however, imaging showed new brain disease and other progression. She stopped afatinib and continued to decline systemic chemotherapy. A colonoscopy performed for lower abdominal pain found small cell cancer deposits in the ascending and sigmoid colon. When headaches worsened, she agreed to brain radiotherapy and received 30 Gy in 10 fractions from July 11 to July 22, 2016. Her disease continued to advance, and she died from respiratory failure on August 1, 2016.