Second-line afatinib administration in an elderly patient with squamous cell carcinoma

Abstract

Introduction: The majority of cases of lung cancer are still diagnosed at a late stage. At this stage, palliative therapeutic options including nonspecific cytotoxic drugs, targeted therapy, or immunotherapy can be utilized. In 2016, immunotherapy was approved in Europe for squamous cell carcinoma and adenocarcinoma. Moreover, afatinib was also approved as second-line therapy for squamous cell carcinoma.

Case report: This article presents a case of a 76-year-old male with squamous cell carcinoma who received nab-paclitaxel as first-line therapy, and his treatment was switched to the tyrosine kinase inhibitor afatinib (40 mg) after disease progression with left lung atelectasis. After receiving afatinib for only 28 days, the atelectasis resolved. No adverse effects were observed from the afatinib therapy.

Discussion: In this case, afatinib 40 mg proved to be an effective alternative treatment for an elderly patient. Treatment choice should be based on the performance status of the patient, cost-effectiveness, and drug treatment guidelines.

Keywords: EGFR; afatinib; lung cancer.

Figure 1

Left lung atelectasis (during abraxane, last therapy session); white arrow indicates the central mass to the left main bronchus.

Figure 2

Computed tomography scan of the thorax (during abraxane); the left lung is totally collapsed (white arrow).

Figure 3

After 28 days under afatinib 40 mg (the mass has started to shrink and the left lung to inflate, white arrow).

Figure 4

After 65 days from the afatinib 40 mg administration (white arrow indicates the part of the left lower lobe that has been inflated and red arrow indicates the central mass that used to totally block the left lung).