Onkológia 3/2020

Effectivity of reduced dose of afatinib in patient with metastatic del 19 adenocarcinoma

Purpose: This case report aims to demonstrate effectivity of reduced dose of afatinib in patient with metastatic del 19 adenocarcinoma with very poor performance status. Case: We describe 53-years-old female patient, smoker, with lung adenocarcinoma. First line chemotherapy had partial radiologic response, however due to hematotoxicity, GI intolerance and worsening of general condition of patient had to be stopped. After ctDNA confirmation of del 19 of EGFR gene treatment with afatinib in reduced dose was started despite of very poor performance status, chronic respiratory failure and cancerous cachexia. Response to treatment was very effective with relevant clinical improvement of patient’s condition. Osteoblastic bone flare reaction as a sign of response to EGFR-TKI has been observed during the treatment. Conclusion: TKIs are standard of care of lung adenocarcinoma with driver mutations over last decade. The detection of genetic alterations of DNA is based on molecular genetics analysis of tumor cells or circulating tumor DNA (ctDNA). The most frequent targetable genetic alterations are activating mutations of EGFR gene. Deletion 19 has the best prognostic outcome of EGFR mutations with TKI treatment.

Keywords: lung adenocarcinoma, EGFR, del 19, afatinib, osteoblastic flare