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Case Reports
. 2022 Apr 21;11(1):LMT54.
doi: 10.2217/lmt-2021-0001. eCollection 2022 Mar.

Exceptional response to afatinib in a patient with persistent G719A EGFR-mutant NSCLC

Amit A Kulkarni  1 , Naomi Fujioka  1 , Lucia Reinhardt  1 , Manish R Patel  1 , Robert A Kratzke  1
Affiliations
Case Reports

Exceptional response to afatinib in a patient with persistent G719A EGFR-mutant NSCLC

Amit A Kulkarni et al. Lung Cancer Manag. .

Abstract

We present a patient with metastatic NSCLC harboring a compound EGFR mutation with co-occurring G719A and T790M mutation. T790M mutation was treatment emergent mutation when patient was on early generation tyrosine kinase inhibitors. Initial Guardant 360 showed that G719A was the dominant clone. Following, osimertinib, the patient had only a radiographic disease stabilization and then developed both clinical and radiographic progression. On progression, T790M was undetectable but G719A continued to be the dominant clone. Subsequent administration of afatinib led to a clinical and radiological response. To our knowledge, this is the first case report describing co-occurrence of EGFR G719A and T790M mutations and the clonal evolution during treatment with anti-EGFR therapies.

Keywords: EGFR mutation; NSCLC; afatinib; compound mutations; liquid biopsy; mutations; next-generation sequencing; osimertinib; rare mutations; uncommon tyrosine kinase inhibitors.

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Conflict of interest statement

Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Serial CT scan axial sections at same level showing evolution of cancer captured at the time of progression on treatments.
(A) Progression on gefitnib in April 2010. (B) Progression on erlotinib in July 2016. (C) Progression on osimertinib in November 2019. (D) Response on afatinib in April 2020.
See this image and copyright information in PMC

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