Related Experiment Video
Updated: Oct 13, 2025
Establishment and Characterization of Three Afatinib-resistant Lung Adenocarcinoma PC-9 Cell Lines Developed with Increasing Doses of Afatinib
Published on: June 26, 2019
An elderly advanced non-small cell lung cancer patient harboring rare epidermal growth factor receptor mutations
Fanjie Qu1, Shuang Wu, Huacheng Dong
1Department of Oncology, Dalian Third People's Hospital, Dalian, China.
Rationale:
Tyrosine kinase inhibitors (TKIs) have significant efficacy in patients with advanced non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutations. No clear evidence exists that EGFR-L861R is sensitive to TKIs, and the best treatment for NSCLC patients with EGFR-L861R mutation is undetermined.
Patient Concerns:
We report the characteristics, efficacy, and adverse events of a patient harboring rare EGFR mutations L861R treated with afatinib, and summarize the currently available evidence and ongoing clinical trials regarding it.
Diagnosis:
The patient was diagnosed with advanced lung cancer that had progressed after previous osimertinib drug therapy, based on the clinical course and imaging findings.
Interventions:
The patient underwent genetic testing, and next-generation sequencing detected rare EGFR mutations L861R in the plasma (mutation abundance 8.1%). The patient was then administered afatinib at 30 mg quaque die combined with bevacizumab at 300 mg every 2 weeks.
Outcomes:
After 1 month of treatment, the patient achieved a quick response, and symptoms improved significantly. Repeat evaluation imaging demonstrated that the lesions in the lung and brain were significantly smaller and evaluation showed partial remission. However, despite showing an initial response, the patient presented with behavioral abnormalities, headaches, and sudden confusion after 2 months, and subsequently appeared coma. The family elected to forgo further therapy due to the patient's age and enrolled in hospice care, passing 14 months after the initial diagnosis.
Lesson:
EGFR-L861R mutation could help predict the sensitivity of patients with advanced NSCLC to TKIs.
Insights
This case study explores the rare EGFR-L861R mutation in advanced non-small cell lung cancer (NSCLC). Afatinib showed initial efficacy but led to severe adverse events, highlighting treatment challenges for this mutation.
Area of Science:
- Oncology
- Genetics
- Pharmacology
Background:
- Advanced non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutations is often treated with tyrosine kinase inhibitors (TKIs).
- The sensitivity of the rare EGFR-L861R mutation to TKIs remains unclear, with no established optimal treatment strategy.
- This study investigates a patient with advanced NSCLC harboring the EGFR-L861R mutation, previously treated with osimertinib.
Observation:
- A patient with advanced NSCLC and a rare EGFR-L861R mutation (8.1% abundance) was treated with afatinib and bevacizumab.
- Initial treatment resulted in rapid symptomatic improvement and partial remission of lung and brain lesions.
- Within two months, the patient developed severe neurological adverse events, including confusion and coma.
Findings:
- The EGFR-L861R mutation was detected in plasma via next-generation sequencing.
- Afatinib demonstrated initial, albeit temporary, efficacy in reducing tumor burden and improving symptoms.
- The patient experienced significant and ultimately fatal neurological toxicity attributed to the treatment.
Implications:
- The EGFR-L861R mutation may influence TKI sensitivity in advanced NSCLC.
- This case underscores the potential for severe adverse events with TKIs in patients with rare EGFR mutations.
- Further research is needed to determine optimal treatment paradigms for NSCLC patients with the EGFR-L861R mutation.
More Related Videos
09:38Establishing Dual Resistance to EGFR-TKI and MET-TKI in Lung Adenocarcinoma Cells In Vitro with a 2-step Dose-escalation Procedure
Published on: August 11, 2017
13:34A Combined 3D Tissue Engineered In Vitro/In Silico Lung Tumor Model for Predicting Drug Effectiveness in Specific Mutational Backgrounds
Published on: April 6, 2016
Related Concept Videos
02:38Mitogens and the Cell Cycle
02:57Targeted Cancer Therapies
There are several types of targeted therapies against...
02:56Treatment Resistant Cancers
02:23Abnormal Proliferation