NRG1-Fusion Lung Cancer With a 24-Month Response to Afatinib

What happened, in summary

A 56-year-old woman who had never smoked was diagnosed with nonmucinous lung adenocarcinoma in 2004. She underwent lobectomy, but the cancer returned in the left lung in 2006. Over the following years, she received 14 lines of systemic treatment, including carboplatin with gemcitabine, erlotinib, pemetrexed, docetaxel, gefitinib, vinorelbine, paclitaxel, and additional gemcitabine. Most produced progression or only short-lived control. Left-lung metastases near the chest wall were treated with 30 Gy of palliative radiation in 2011.

Afatinib began in February 2015 and was increased from 30 mg to 40 mg daily. Imaging showed a rapid partial response after about 2.5 months, which continued for 24 months. After progression, further pemetrexed and gemcitabine did not control the disease. Expanded testing then identified an NRG1 fusion.

Afatinib was restarted in October 2017 and again in April 2018, each time relieving her cough and reducing lung disease for a period. Pulmonary symptoms and infiltrates required interruptions, antibiotics, and corticosteroids. Progression in August 2018 led to 6 cycles of atezolizumab. The cancer continued to progress, and she died in May 2019.