Prolonged survival with erlotinib followed by afatinib in a caucasian smoker with metastatic, poorly differentiated large cell carcinoma of the lung: a case report

Abstract

Keywords: afatinib, case report, EGFR mutation, non-small cell lung cancerAbbreviations: CT, computed tomography; EGFR, ErbB1, epidermal growth factor receptor; NSCLC, non-small cell lung cancer; PFS, progression-free survival; PR, partial response; RUL, right upper lobe; TKI, tyrosine kinase inhibitor.Activating mutations in the tyrosine kinase domain of the epidermal growth factor receptor (EGFR; ErbB1) -either exon 19 deletions or exon 21 point mutations -are associated with hypersensitivity to EGFR tyrosine kinase inhibitors (TKIs). EGFR mutations are more frequently found in females, non-smokers, Asians, and patients with adenocarcinoma. We report the case of a 51-year-old Caucasian woman with metastatic NSCLC harboring an EGFR exon 19 deletion although she was a smoker and had a poorly differentiated large cell carcinoma. Following a partial response on 4 months of chemotherapy, the patient progressed and was treated with the reversible EGFR TKI erlotinib for 3 y. The patient then developed resistance to erlotinib and went on to receive the irreversible ErbB Family Blocker afatinib for 1 year, attaining a partial response at 4 months. The impressive survival time attained by our patient highlights the clinical benefit of targeting one or more members of the ErbB Family in patients with disseminated NSCLC and EGFR activating mutations.

Molecular Pathology and Personalized Medicine: The Dawn of a New Era in Companion Diagnostics—Practical Considerations about Companion Diagnostics for Non-Small-Cell-Lung-Cancer

“…During the following years, various immunohistochemical markers enabled pathologists to define more distinct histopathological subgroups, different therapeutic agents were developed, and their use in distinct histopathologic entities were optimized [ 2 ]. All this interdisciplinary research led to a median survival of 12, or more, months in patients with metastasising lung cancer [ 9 , 10 , 11 , 12 , 13 ]. The discovery of single mutations which could be used for cancer treatment in the beginning of the new millennium facilitated an individualized treatment even if mainly limited to non-smokers and adenocarcinomas (ACs).…”