Afatinib administration in a patient with non-small cell lung cancer harboring uncommon EGFR mutation G719A undergoing hemodialysis

Recent analysis indicated that afatinib could be effective in treating non-small cell lung cancer harboring uncommon EGFR mutations. A 59-year-old man undergoing hemodialysis for chronic renal failure was diagnosed with adenocarcinoma of the lung (cT4N3M1b). EGFR mutation analysis of his cancer revealed G719A point mutation in exon 18, and we started daily administration of 30. mg afatinib with hemodialysis (three times a week). As the feasibility of afatinib in patients with chronic renal failure undergoing hemodialysis has not been established, we analyzed the pharmacokinetics of afatinib in this patient. The trough level of afatinib in his plasma was almost similar to that of patients with normal renal function. Two months later there was marked tumor shrinkage, indicating a partial response. Our results suggest that afatinib could be safely administered and may exhibit good tumor response in a patient who has advanced lung adenocarcinoma with uncommon mutations undergoing hemodialysis.