Successful Treatment of Lung Adenocarcinoma with Epidermal Growth Factor Receptor Compound Mutations Involving Exon 19 Deletion and Exon 20 Insertion by Afatinib

Intern Med. 2019;58(1):101-104. doi: 10.2169/internalmedicine.0927-18. Epub 2019 Jan 1.


A 70-year-old woman was referred to our hospital after a nodular shadow was noted on chest X-ray. Chest computed tomography showed a pulmonary mass in the right upper lobe, and brain magnetic resonance imaging revealed a right-sided frontal lobe tumor. A histological examination of a transbronchial lung biopsy specimen revealed adenocarcinoma with epidermal growth factor receptor mutations involving both exon 19 deletion and exon 20 insertion. After stereotactic radiotherapy for brain metastasis, the patient was treated with afatinib, which resulted in a complete response. We observed a case in which a patient had non-small cell lung cancer with compound EGFR mutations involving both exon 19 deletion and exon 20 insertion mutations that responded well to afatinib therapy.

Keywords: afatinib; complete response; compound mutation; exon 19 deletion; exon 20 insertion.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma of Lung / drug therapy*
  • Adenocarcinoma of Lung / genetics
  • Afatinib / therapeutic use*
  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Brain Neoplasms / secondary
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / genetics
  • ErbB Receptors / genetics*
  • Exons / genetics*
  • Female
  • Humans
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / genetics
  • Mutagenesis, Insertional
  • Quinazolines / administration & dosage
  • Sequence Deletion


  • Antineoplastic Agents
  • Quinazolines
  • Afatinib
  • ErbB Receptors