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Emergence of drug resistance: case report A 62-year-old man exhibited acquired drug resistance during treatment with erlotinib and afatinib for lung squamous cell carcinoma (LUSC). The man was diagnosed with lung squamous cell carcinoma (LUSC) with EGFR L861Q mutation in October 2017. He started receiving oral erlotinib and oral afatinib for two and three months, respectively [dosages not stated]. Afterwards, pembrolizumab followed by nivolumab and bevacizumab was administered. He was admitted to hospital for review. CT scan revealed disease progression with enlarged chest wall and lung metastatic nodules. Repeat biopsy of the chest wall nodules confirmed LUSC. He was treated with TP regimen including paclitaxel [albumin paclitaxel] and nedaplatin along with endostatin [endostar]. Six months later, head MRI revealed abnormal signals in the bilateral frontal lobe, right cerebellum and right parietal lobe suggestive of the possible tumour metastasis. Genomic profiling of the tumour tissue revealed additional mutations including copy number variation (CNV) of CDK4 (6.59 fold) and MDM2 (7.19 fold) along with pre-existing EGFR L861Q mutation. These were indicative of acquired drug resistance due to erlotinib and afatinib. The man received treatment with palbociclib combined with afatinib. He experienced grade 1 myelosuppression, mild anaemia and thrombocytopenia following the therapy, which improved later. After two months, CT showed shrinkage of irregular soft tissue mass in the right midaxillary line and right anterolateral chest wall. Additionally, four nodules disappeared in the right lung. He achieved partial response with decreasing level of carcinoembryonic antigen. The treatment with palbocicib and afatinib was continued. Jiang H, et al. EGFR L861Q and CDK4 amplification responding to afatinib combined with palbociclib treatment in a patient with advanced lung squamous cell carcinoma. 803497479 Lung Cancer 145: 216-218, Jul 2020. Available from: URL: http://doi.org/10.1016/j.lungcan.2020.04.001

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Reactions 22 Aug 2020 No. 1818