• Sixian Chen, Tianmin Xiang, Wei Lu, Shuiqiang Hong, Yuanyuan Li, Yuan Lu, Qiongyue Zhang, Yongfeng Chen, Suli Zhou, Gehui Wang, Zhenzhen Zhang, and Yongguang Cai.
• Medical Oncology Department V, Guangdong Nongken Central Hospital, Zhanjiang.
• Medicine (Baltimore). 2021 Feb 26; 100 (8): e24380e24380.

IntroductionAcquired resistance to reversible EGFR tyrosine kinase inhibitors remains a significant obstacle, and acquired ERBB2 amplification is the most common "bypass" mechanism. For patients with sensitizing EGFR mutation who experience resistance via ERBB2 amplification, no targeted drug has been demonstrated to be effective.Patient ConcernsA 56-year-old female nonsmoker suffered from left leg paralysis and low back pain. Imaging examination revealed a mass in the anterior segment of the right upper lobe lung and possible multiple metastases in the right hilar, mediastinal lymph nodes, bone metastases, and soft tissue invasion.DiagnosisTransbronchial lung biopsy revealed a moderately differentiated adenocarcinoma (cT4N2M1c, stage IV). An EGFR exon 19 deletion was identified using amplification refractory mutation system.InterventionsAfter the patient was treated with gefitinib initiation (250 mg/d) for 15 months, the tumor progressed with ERBB2 amplification revealed by next-generation sequencing test. Then, the patient was started on afatinib (40 mg/d) plus bevacizumab (7.5 mg/kg every 3 weeks).OutcomesThe combination therapy of afatinib and bevacizumab in this patient was effective with some slight side effects. Computed tomography scans showed the tumor shrinkage and the pleural effusion disappeared in the right lung. The overall survival was 23.5 months.ConclusionTo date, there is no targeted therapy approved and demonstrated to be effective for non-small cell lung cancer patients with EGFR sensitizing mutations, and ERBB2 amplification. The effectiveness of combination therapy with afatinib and bevacizumab may provide a new therapeutic option for these patients.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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