AFATINIB MONOTHERAPY FOR DOUBLE-PRIMARY LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER EXON-21 L861Q MUTATION WITH HISTORY OF COLORECTAL CANCER

Juli Jamnasi; Rudiyo Yeoh; Sudibio Sudibio; Hendrik Hendrik

doi:10.32532/jori.v15i1.164

AFATINIB MONOTHERAPY FOR DOUBLE-PRIMARY LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER EXON-21 L861Q MUTATION WITH HISTORY OF COLORECTAL CANCER

Juli Jamnasi, Rudiyo Yeoh, Sudibio Sudibio, Hendrik Hendrik

Sari

Introduction: Uncommon mutation exon-21 L861Q is a rare type Non-Small Cell Lung
Cancer (NSCLC). Despite the limited data regarding this type of mutation, Afatinib as one of the oral tyrosine kinase inhibitors (TKI) shows good anti-tumor activity.
Clinical Features: A 50-year-old woman with a history of post-operative colorectal cancer (2014) without undergoing chemotherapy and radiotherapy; came in October 2020 with severe dyspnea due to massive pleural effusion with a right lower lung bulky mass. Histopathology in 2014 was a low-grade adenocarcinoma colorectal cancer, while the biopsy of the right lung mass in 2020 was a mucinous adenocarcinoma, ALK-negative, TPS 1.75, and exon-21 L861Q mutation.
Intervention and Outcomes: The patient underwent thorax drainage to evacuate pleural effusion fluid. Through multidisciplinary discussions, the patient was recommended to take the oral drug TKI Afatinib 40 mg OD in January 2021. On the 2nd week of taking Afatinib, the patient complained of painful swallowing, mouth sores, sore tongue, and joint pain throughout the body; confirmed to be the side effects of the drug. Complaints diminished with supporting drugs, however, did not resolve completely. CT scan in April 2021 showed a significant reduction in lung mass. Due to severe side effects and drastic weight loss, the Afatinib dose was reduced to 20 mg OD. Radiotherapy was incorporated in her treatment session with IMRT to cover the whole tumor.
Discussion: Determining the best treatment to treat the patient was initially difficult due to the raising doubt regarding the correlation between the current lung cancer with her previous history of colorectal cancer. Treating the newer lung mass as primary cancer was obviously different rather than treating lung metastatic colorectal cancer. This issue could then be resolved by incorporating more thorough NGS examination. With the finding of exon-21 L861Q mutation in this patient, Afatinib monotherapy is considered the therapy of choice.

Kata Kunci

lung cancer; colorectal cancer; uncommon mutation; NSCLC; exon 21; L861Q; Afatinib

Teks Lengkap:

PDF (English)

Referensi

Yang JCH, Schuler M, Popat S, Miura S, Heeke S, Park K, et al. Afatinib for the Treatment of NSCLC Harboring Uncommon EGFR Mutations: A Database of 693 Cases. J Thorac Oncol [Internet]. 2020;15:803–15. Available from: https://pubmed.ncbi.nlm.nih.gov/31931137/

Zhang T, Wan B, Zhao Y, Li C, Liu H, Lv T, et al. Treatment of uncommon EGFR mutations in non-small cell lung cancer: new evidence and treatment. Transl Lung Cancer Res [Internet]. 2019;8:302–16. Available from: https://pubmed.ncbi.nlm.nih.gov/31367543/

Yamada Y, Tamura T, Yamamoto Y, Ichimura H, Hayashihara K, Saito T, et al. Treatment of Patients With Non-small-cell Lung Cancer With Uncommon EGFR Mutations in Clinical Practice. Anticancer Res [Internet]. 2020;40:5757–64. Available from: https://ar.iiarjournals.org/content/40/10/5757

Passaro A, Mok T, Peters S, Popat S, Ahn MJ, de Marinis F. Recent Advances on the Role of EGFR Tyrosine Kinase Inhibitors in the Management of NSCLC With Uncommon, Non Exon 20 Insertions, EGFR Mutations. J Thorac Oncol [Internet]. 2021;16:764–73. Available from: https://pubmed.ncbi.nlm.nih.gov/33333327/

Harvey RD, Adams VR, Beardslee T, Medina P. Afatinib for the treatment of EGFR mutation-positive NSCLC: A review of clinical findings. J Oncol Pharm Pract [Internet]. 2020;26:1461–74. Available from: https://pubmed.ncbi.nlm.nih.gov/32567494/

Wu SG, Gow CH, Yu CJ, Chang YL, Yang CH, Hsu YC, et al. Frequent epidermal growth factor receptor gene mutations in malignant pleural effusion of lung adenocarcinoma. Eur Respir J [Internet]. 2008;32:924–30. Available from: https://pubmed.ncbi.nlm.nih.gov/18508816/

de Marinis F, Laktionov KK, Poltoratskiy A, Egorova I, Hochmair M, Passaro A, et al. Afatinib in EGFR TKI-naïve patients with locally advanced or metastatic EGFR mutation-positive non-small cell lung cancer: Interim analysis of a Phase 3b study. Lung Cancer [Internet]. 2021;152:127–34. Available from: https://pubmed.ncbi.nlm.nih.gov/33387727/

Sweeney SM, Cerami E, Baras A, Pugh TJ, Schultz N, Stricker T, et al. AACR Project GENIE: Powering Precision Medicine through an International Consortium. Cancer Discov [Internet]. 2017;7:818–31. Available from: https://pubmed.ncbi.nlm.nih.gov/28572459/

van Brummelen EMJ, Huijberts S, van Herpen C, Desar I, Opdam F, van Geel R, et al. Phase I Study of Afatinib and Selumetinib in Patients with KRAS-Mutated Colorectal, Non-Small Cell Lung, and Pancreatic Cancer. Oncologist [Internet]. 2021;26:290-e545. Available from: https://pubmed.ncbi.nlm.nih.gov/33296125/

DOI: https://doi.org/10.32532/jori.v15i1.164 <