Author of

• 30601

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  P2.01 - Advanced NSCLC (ID 159)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 30709

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    P2.01-96 - Response to Anti-HER2 Afatinib in a Case of Invasive Pulmonary Mucinous Adenocarcinoma with a SLC3A2-NRG1 Fusion (ID 205)

    10:15 - 18:15  |  Author(s): Christine Dussopt
    • Abstract
    • Slides

    Background
    

    Background : Neuregulin 1 gene (NRG1) fusions such as SLC3A2-NRG1 have been identified in 6,7% of invasive pulmonary mucinous adenocarcinoma (IMA). This fusion leads to ErbB2 and ErbB3 pathway activation. Theoretically a matched targeted therapy may be afatinib, an oral irreversible ErbB-family inhibitor.

    Method
    

    Methods : We present the case of a 80 year-old non smoker caucasian female with breathless at rest, bronchorrhea, fever, bilateral ground glass opacities and right lower lobe atelectasia. Body CT scan and PET-scanner revealed hypermetabolic multifocal lung involvement. Cytologic examination of bronchioloalveolar lavage revealed adenocarcinomatous cells compatible with IMA. She received first-line gefitinib 250mg per day, antibiotics and solumedrol. After a clinical improvement of 15 days, cough and hypoxemia worsened and CT scan showed pulmonary opacities progression. A SLC3A2(e5)-NRG1(e6) gene fusion was identified with a targeted RNA sequencing performed on cytologic samples (Panel « FusionPlex CTL Kit », ArcherDx). The sample was negative for EGFR ex18 to 21, KRAS, BRAF, PIK3CA, ERBB2, MET mutations. Afatinib 30mg orally once daily was started. At 8-week follow-up, the patient reported resolution of cough, bronchorrhea, hypoxemia and chest CT showed significant improvement of ground glass opacities in the left lower lobe. The clinical response was sustained to week 16, when her bronchorrea and hypoxemia worsened and CT scan showed progression despite an increasing dosage of afatinib at 40mg once daily. She subsequently received carboplatine- paclitaxel- bevacizumab. A progression eventually occurred after 4 months. We rechallenge afatinib 30mg orally once daily and a clinical and imaging response is still ongoing after 8 weeks.

    Result
    

    Results: The clinical efficacy of afatinib in this case was suggestive of an on target effect of afatinib, with rapid clinical improvement and radiographic response despite a disease control shorter than 16 weeks.

    Conclusion
    

    Conclusion: This report offers some evidence of the activity of afatinib in NRG1 gene fusion-positive lung cancer.

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