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S.D. Stefani
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-029 - A Case of a Patient Harboring an EGFR Insertion of Exon 20 and Long Lasting Clinical Response to Afatinib (ID 9136)
09:30 - 16:00 | Author(s): S.D. Stefani
- Abstract
Background:
Lung cancer remains a leading cause of mortality worldwide. Evolution in molecular biology has expanded and the identification of somatic mutations in the epidermal growth factor receptor (EGFR) as a clinically relevant oncogene also selected a subgroup of patients. Most commonly described as activating mutations, both deletion of exon 19 and L858R point mutation in exon 21 account for nearly 90% of all EGFR mutated patients. These patients usually benefit from tyrosine kinase inhibitors (TKIs). On the other hand, some patients harboring specific EGFR mutations – such as exon 20 insertions – do not benefit from the same strategy.
Method:
We describe a case report of a patient with advanced lung cancer. A female, 39-year-old patient was first diagnosed in late 2015 when she presented with dyspnea and lower back pain. Biopsy of the primary lung mass as well as a bone lytic lesion both revealed an adenocarcinoma. PET-CT showed extensive lymphangitic carcinomatosis, bone and cervical lymph node involvement. She underwent 5 cycles of cisplatin-pemetrexed with a good radiologic partial response and very good clinical response. During chemotherapy, the first molecular test (Cobas Z 480 Roche) became available showing an insertion of exon 20 in the EGFR gene.
Result:
Patient then requested an alternative treatment given that she was not inclined to accept maintenance with chemotherapy. We then proposed a short trial with afatinib, even though the chances of response were very low. She was started on afatinib PO 40mg/day on March 14[th,] 2016. Three weeks later the patient developed a grade 3 diarrhea and the drug was withheld until her symptoms resolved. She resumed afatinib PO at 30mg/day on April 20[th,] 2016. Her first radiologic evaluation two months later showed stable disease and she was kept on treatment and reported to feel healthier. Her second evaluation on November 2016 then showed a partial response, mainly in the bone and she was continued on oral TKI. New imaging studies on March 2017 revealed a progression of her disease only 12 months later.
Conclusion:
There is a lack of data addressing patients harboring rare and unique EGFR gene mutations. Most exon 20 insertions identified in patient samples have not been tested against reversible EGFR TKIs. Extrapolations from the few tested mutations might not apply for other exon 20 mutations. It is imperative that patient-derived cell lines of common EGFR exon 20 insertion mutations are developed to enhance our preclinical understanding on these tumors.
