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Establishment and Characterization of Three Afatinib-resistant Lung Adenocarcinoma PC-9 Cell Lines Developed with Increasing Doses of Afatinib
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Sleeve lobectomy for lung adenocarcinoma treated with neoadjuvant afatinib

Ichiro Sakanoue1, Hiroshi Hamakawa1, Reiko Kaji2

  • 1Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.

Journal of Thoracic Disease
|May 1, 2018
PubMed

Insights

Neoadjuvant afatinib therapy in non-small cell lung cancer (NSCLC) showed partial tumor response, enabling lung-sparing sleeve lobectomy. This approach reduced pneumonectomy risk with manageable side effects, achieving 26-month recurrence-free survival.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Advanced non-small cell lung cancer (NSCLC) treatment often involves epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs).
  • Second-generation EGFR-TKIs like afatinib may offer improved efficacy over first-generation agents.
  • Neoadjuvant therapy aims to shrink tumors, potentially allowing less invasive surgical procedures.

Observation:

  • A case study of a lung adenocarcinoma patient (cT3N0M0) with reduced FEV1 and EGFR mutation.
  • Neoadjuvant afatinib (30 mg daily) was administered for 3 weeks prior to sleeve lobectomy.
  • The patient experienced grade 3 diarrhea, necessitating a dose reduction to 20 mg daily.

Findings:

  • Imaging revealed a partial response of the tumor by Day 20 of afatinib treatment.
  • Afatinib was discontinued on Day 22, followed by a sleeve lobectomy on Day 24.
  • The patient experienced an uneventful postoperative recovery and remained recurrence-free for 26 months.

Implications:

  • Neoadjuvant afatinib can facilitate lung-sparing surgery (sleeve lobectomy) in select NSCLC patients.
  • This strategy may reduce the need for pneumonectomy, preserving lung function.
  • Managing side effects like diarrhea is crucial for successful neoadjuvant TKI therapy.
Keywords:
Lung cancerepidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)neoadjuvant therapysleeve lobectomy

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