P46.07 Afatinib-Related Pneumonitis in Metastatic EGFR-Positive NSCLC

Abstract

Lung cancer is the third commonest cancer in Indonesia, and the first case of death in all cancer in both gender. EGFR mutation frequency in cytological sample in Indonesia was 44.4%. Afatinib is second generation epidermal growth factor receptor tyrosine kinase inhibiot, which inhibits epidermal growth factor receptor (EGFR), human epidermal factor receptor-2 (HER2) and HER4. Afatinib first introduced in Indonesia in 2016, and get approval for national health insurance program in 2018. The side effect of afatinib are skin rash, diarrhea, paronichia and pneumonitis. Here were reported a 69 yo female with diagnosis of lung adenocarcinoma T3N3M1 brain, lung EGFR mutation exon 19 deletion. She was treated with afatinib 40mg. Her condition was improved, but after 2 months of treatment, she complained of cough and shortness of breath. On chest HRCT showed bilateral pneumonitis. After inclusion of infection and heart failure, she was treated with pulse-dose steroid, but her condition deterioriated, and she passed away with respiratory failure. This is a case report, written informed consent has been obtained from her family member. HRCT of lung showed bilateral pneumonitis. Pneumonitis is a very rare adverse event of EGFR TKI, however can be devastating. We reported acute pneumonitis related to afatinib in metastatic adenocarcinoma, although already been diagnosed and treated early, but difficult to manage.