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A 65-year-old man with a 30-pack-year smoking history developed right-sided chest pain and fatigue. CT showed a tumor in the left lung with enlarged mediastinal lymph nodes, and he also had enlarged right cervical lymph nodes. Biopsy of a cervical node confirmed lung adenocarcinoma.
Genetic testing found 2 uncommon EGFR mutations, L861Q and G719X. Further imaging showed multiple metastases in the ribs on both sides. His disease was Stage IV.
He started afatinib at 80 mg by mouth each day. One month later, CT showed shrinkage of the primary lung tumor and the enlarged mediastinal lymph nodes. The main reported adverse effect was grade II skin toxicity, with no severe toxicity described.
The response proved unusually durable for this rare mutation combination. CT scans performed 30 months after treatment began showed no recurrence, and he remained well 32 months after starting afatinib. The response remained durable despite the uncommon EGFR mutation combination.
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
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