Response of Leptomeningeal Metastases inEGFR-Mutated Non-Small-Cell Lung Cancer to Afatinib in theAbsence of Radiotherapy

Palliative radiotherapy is currently the medical standard of care for non-small-cell lung cancer (NSCLC) patients with symptomaticCNS and leptomeningeal disease. We report the case of a 62-year-old male patient with EGFRmutation(del19+) NSLC withsymptomatic lymph node, bone, CNS, and leptomeningeal metastases. Taking into account on one hand the response totyrosine kinase inhibitors (TKIs) and on the other hand the short- to medium-term side effects of radiotherapy and the lack oftimely availability in our healthcare system, the patient was treated with afatinib (40 mg daily) and exhibited a rapid responsewith improvement of neurological symptoms. The patient presented partial response of extracranial, CNS, and leptomeningeallesions at 3, 6, and 12 months of treatment, currently completing 16 months of progression-free survival despite presenting milddermatological and gastrointestinal toxicities. Afatinib is an effective and safe option in patients with NSLC EGFRmutationdel19+ with CNS and leptomeningeal compromise avoiding or delaying radiotherapy and its side effects, especially in countrieswhere there is a lack of access to this kind of therapy