LUNG CANCER METASTASES IN THE BRAIN: MAJOR RESPONSE WITH AFATINIB

Abstract

TYPE: Late Breaking Abstract TOPIC: Lung Cancer INTRODUCTION: Lung cancer (LC) is the leading cause of cancer-related death worldwide and it is responsible for nearly 50% of brain metastasis (BM) cases. Afatinib is a second-generation irreversible EGFR tyrosine kinase inhibitor, indicated in the treatment of metastatic LC with activating EGFR mutations. CASE PRESENTATION: A 71-year-old woman, ECOG PS 1, was diagnosed with stage IVb LC (T3N0M1b), EGFR mutated (exon 18: Glu790Lys, Lys744Asn, Gly719Ser). Staging brain MRI showed 2 left brain lesions, suggestive of BM, not surgically approachable: one in the parietal region (20x16mm) and another (3mm) in the temporo-occipital transition. In the Multidisciplinary Tumor Board was decided treatment with afatinib and stereotactic brain surgery (SBS). To plan SBS another brain MRI was performed showing a significant reduction of the left parietal lesion (10x8mm; figure 1) and complete disappearance of the other lesion, after 8 days of treatment, and SBS was canceled. Reevaluation after 3 months revealed partial imaging response on the lung and brain (BM with 9mm, major axis). Due to grade 2-3 skin rash and paronychia, the treatment dose was reduced until 20mg/day, with good tolerance. DISCUSSION: Despite having incomplete blood-brain barrier penetration, afatinib has the potential to treat LC BM, with a reported intracranial response rate ranging from 35%-72.9%. This efficacy was demonstrated in this case report, allowing brain radiation sparing strategy. CONCLUSIONS: This case report shows the effectiveness of afatinib in BM from EGFR mutated lung adenocarcinoma. DISCLOSURE: No significant relationships. KEYWORD: Brain metastases