PMC10051041_01
Efficacy of EGFR-TKIs. a Chest CT shows primary lesion in right upper lobe. b Partial response was achieved with afatinib. c Re-growth of primary lesion was detected in 2020 and lobectomy of right upper lobe was performed. d Malignant pleural effusion appeared in December 2021 but disappeared with osimertinib.
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F1
In April 2015, a 64-year-old male had the diagnosis of stage IV (The 7th edition of the staging system by the Union for International Cancer Control) lung adenocarcinoma harboring EGFR del 19 mutation (Fig. 1a). Partial response was achieved, though the dose was reduced to 30 mg per day due to grade 3 rash (Fig. 1b). In August 2021, he underwent right upper lobe lobectomy because of oligo-progression (Fig. 1c). In November 2021, pleural effusion was detected and cytology with pleural effusion revealed adenocarcinoma (Fig. 1d).
Repeated TAPO with afatinib. Representative episode of repeated TAPO. All opacities improved spontaneously.
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F2
In January 2016, CT showed ground glass opacity with bronchiectasis in right middle lobe (irregular boundary with diameter of 16 mm), which resolved spontaneously 2 weeks later (Fig. 2). Thereafter, recurrent GGO was revealed with chest CT, but all opacity improved without any medication (i.e., corticosteroids) or stopping afatinib (Fig. 2).