PMC6344163_01
Insertion site of EGFR exon20 insertion mutants. (a) Previous reported Exon 20 insertion mutations. Prevalence of each mutation spectrum (noted as insX to represent all known insertions within those residues) by amino acid position is indicated in parentheses. (b) Gene analysis and MA from sequential tumor biopsy specimens by quantitative real-time PCR before treated with osimertinib. (c) Gene analysis and MA; amplified gene shows only AT from pleural effusion by NGS of the whole-exome after treatment with osimertinib. AT = amplification time, EGFR = epidermal growth factor receptor, MA = mutation abundance, NGS = next generation sequencing.
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Chinese woman who had never smoked visited our lung cancer clinic in March 2017 due to a chronic cough. Computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) revealed a mass in the left lower lobe, left pleural metastasis and left malignant pleural effusion (Fig. 1). Fig. 1, according to Hiroyuki Yasuda). From the end of August 2017, the patient was treated with afatinib (40 mg/day), with informed consent.
Patient clinical course including treatment history and relevant imaging studies. (1) At baseline before osimertinib, showing left pulmonary lesion and left pleural effusion. (2) At 1.5 months of osimertinib, with an SD response. (3) At 2.5 months of osimertinib, with an SD response. (4) At 4.4 months of osimertinib, lung and left pleural effusion progression. (5) At 4.0 months of treatment with afatinib, left pulmonary lesion was stable disease and the pleural effusion was significantly reduced. (6) At 7.4 months of treatment with afatinib, with progressed disease with left pulmonary lesion and stable pleural effusion. SD = Stable Disease.
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PFS was 7.4 months (Fig. 2).