Management of EGFR-mutant non-small cell lung cancer. Treatment with afatinib: a case report

Approximately 10-40% of patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) harbor a somatic mutation in epidermal growth factor receptor (EGFR) gene. Tyrosine kinase inhibitors (TKIs) against EGFR have increasingly been associated with improved clinical outcomes in patients with advanced EGFR-mutant NSCLC. First-generation reversible EGFR TKIs, gefitinib and erlotinib, have been proven to improve the objective response rate and to prolong the progression-free survival compared with standard chemotherapy in large phase III trials. Afatinib is an irreversible EGFR inhibitor. Compared with gefitinib in a first-line setting, afatinib prolonged progression-free survival and time to treatment failure. Afatinib has been shown to prolong overall survival in the subset of patients with an EGFR exon 19 deletion compared with chemotherapy. Presentation : We report a case of advanced lung adenocarcinoma in patient 56 years old with activating EGFR mutation (L858R) treated with afatinib, standard chemotherapy, and brain radiation for 3 years. During the treatment period we successfully returned to afatinib therapy three times. Conclusion : Afatinib is an affective EGFR TKIs inhibitor which successfully can be used in a first-line setting in advanced EGFR-mutant NSCLC.