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Case Report


Response to afatinib, after gefitinib and erlotinib, in a patient with advanced adenocarcinoma of lung with brain metastasis: A case report

Prashant MehtaPranjit Santonu BhajoniSwati Pabbi Mehta
Department of Medical Oncology/Hematology/BMT, Asian Institute of Medical Sciences, Faridabad, Haryana1Department of Pharmacology, PGIMER, Dr.Ram Manohar Lohia Hospital, NewDelhi, 2Department of Pathology, Sardar Patel Medical College, Bikaner, Rajasthan, India, 
Corresponding Author:

Prashant Mehta

Asian Institute of Medical Sciences, Faridabad, Haryana, India
E-mail: prashant.mehta@aimsindia.co.in

Corresponding Author:

Prashant Mehta

Asian Institute of Medical Sciences, Faridabad, Haryana, India
E-mail: prashant.mehta@aimsindia.co.in

DOI:10.18203/issn.2456-3994.IntJMolImmunoOncol20170056

ABSTRACT


Non-small-cell lung cancer (NSCLC) accounts for 80–85% of all lung cancer cases. The majority of patients present with advanced disease. Adenocarcinoma of the lung forms one of the major histopathological subtypes of metastatic NSCLC. A 70-year-old male was diagnosed with adenocarcinoma right lung with clinical staging of cT2N0M0 in 2012. Patient was treated with adjuvant chemotherapy with 4 cycles of vinorelbine and cisplatin followed by image guided radiation therapy that was completed in November 2012. The patient was started on gefitinib in Jan 2014 till January 2015 due to recurrence and progression and was subsequently switched to erlotinib as the gefitinib was becoming ineffective. However, the patient developed toxicity leading to diarrhea, and the patient had to discontinue erlotinib. In view of poor general condition of the patient (ECOG performance status 4), and progression post gefitinib and erlotinib he was deemed unfit for chemotherapy and it was decided to start the patient on afatinib 40 mg once a day in July 2015, to which the patient responded. The patient showed significant improvement on afatinib. The response though partial and incomplete was substantial and further improvement was very much expected unfortunately the patient succumbed to a lower respiratory tract infection in November 2015.
Keywords: Adenocarcinoma lung, Afatinib, Afatinib after gefitinib and erlotinib, Brain metastasis, Erlotinib, Gefitinib