Case sharing of a patient re-challenged with afatinib for EGFR-mutated advanced non-small cell lung cancer.

A 65-year-old female with diabetes mellitus but otherwise good health in the past suffered from cough with occasional blood-stained sputum during initial presentation. The patient was diagnosed with pulmonary poorly differentiated adenocarcinoma with an epidermal growth factor receptor (EGFR) exon 19 deletion and hence received afatinib therapy for 25 months without obvious adverse events except for a grade 1-2 acneiform rash. The disease was stabilized after subsequent cycles of chemotherapy with pemetrexed and carboplatin followed by maintenance pemetrexed. The patient was rechallenged with afatinib treatment as a named-patient drug in July 2014 (after approval) and later received afatinib in combination with palliative radiation. A blood test confirmed the presence of the T790M mutation and the patient was on osimertinib as part of a compassionate use program. The patient experienced good drug tolerance and eventually had a significant drop in tumor marker levels. This case provides insight into the use of afatinib in first-line setting of EGFR-mutated lung cancer.