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A novel EGFR exon 21 indel mutation in lung adenocarcinoma and response to dacomitinib: A case report
Tao Zhou1, Qiang Xiong1,2, Chen Hong1
1Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Rationale:
Uncommon epidermal growth factor receptor (EGFR) mutations are increasingly being identified in non-small cell lung cancer. Insertion and deletion mutations have been detected in exons 18, 19, and 20, but not in exon 21. In patients with uncommon mutations, the second-generation EGFR tyrosine kinase inhibitor afatinib has shown good efficacy, whereas that of dacomitinib, another second-generation EGFR-tyrosine kinase inhibitor, remains unknown. Here, we reported a patient with a novel EGFR21 exon insertion-deletion (indel) mutation and demonstrated the efficacy of dacomitinib.
Patient Concerns:
A 59-year-old nonsmoking Chinese male was admitted to the hospital with lung cancer after a chest computed tomography for coughing and sputum. The patient's condition progressed after multiple treatments including surgery, chemotherapy, and radiotherapy.
Diagnosis:
The patient had clinical manifestations of cough and sputum and was pathologically confirmed to have T2bN1M0 (stage IIB) lung adenocarcinoma according to the seventh edition of tumor-node-metastasis staging. The patient underwent a second operation after detection of recurrence, and postoperative pathology confirmed adenocarcinoma of the lung. The patient progressed again after surgery, and the tumor-node-metastasis stage was changed to T4N0M1a (stage IVA) before treatment with dacomitinib.
Interventions:
After detection of the EGFR exon 21 indel mutation, the patient began treatment with dacomitinib (45 mg once a day) on March 12, 2021.
Outcomes:
After 1 month of targeted therapy, the patient showed a partial response to dacomitinib. As of March 19, 2022, his condition remained stable and he continued to receive dacomitinib. Progression-free survival reached 12.4 months. The patient experienced mild adverse reactions of pruritus during the use of dacomitinib, but recovered after drug treatment.
Lesson:
We reported a novel EGFR exon 21 indel mutation in a lung adenocarcinoma patient. Dacomitinib showed efficacy in the treatment of a patient with this mutation, suggesting that its efficacy in patients with uncommon mutations should be explored further. The next-generation sequencing is recommended as a guiding tool for the treatment of advanced non-small cell lung cancer.
Insights
A novel epidermal growth factor receptor (EGFR) exon 21 insertion-deletion mutation was identified in a lung cancer patient. Dacomitinib demonstrated efficacy in treating this uncommon EGFR mutation, highlighting its potential for advanced non-small cell lung cancer.
Area of Science:
- Oncology
- Genetics
- Pharmacology
Background:
- Uncommon epidermal growth factor receptor (EGFR) mutations are increasingly identified in non-small cell lung cancer (NSCLC).
- Second-generation EGFR tyrosine kinase inhibitors (TKIs) like afatinib show efficacy in patients with uncommon mutations, but dacomitinib's efficacy is less understood.
- This study reports a novel EGFR exon 21 insertion-deletion (indel) mutation.
Observation:
- A 59-year-old male with advanced lung adenocarcinoma (stage IVA) presented with cough and sputum.
- The patient had progressed despite multiple prior treatments including surgery, chemotherapy, and radiotherapy.
- A novel EGFR exon 21 indel mutation was detected.
Findings:
- The patient received dacomitinib (45 mg daily) for the EGFR exon 21 indel mutation.
- After one month, a partial response was observed, with the condition remaining stable for over 12 months.
- Progression-free survival reached 12.4 months, with manageable adverse events (pruritus).
Implications:
- Dacomitinib demonstrates potential efficacy against a novel EGFR exon 21 indel mutation in NSCLC.
- Further investigation into dacomitinib's effectiveness for uncommon EGFR mutations is warranted.
- Next-generation sequencing is a valuable tool for guiding treatment decisions in advanced NSCLC.
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