RTP On Demand — Head & Neck/Thyroid | Research To PracticeCase: A 55-year-old patient with metastatic head and neck cancer who received afatinib on a clinical trial
2:46 minutes.
TRANSCRIPTION:
DR COHEN: We treated a patient — this was on a clinical trial with afatinib — who unfortunately developed locally recurrent disease as well as metastatic disease after curative-intent therapy. He developed disease about 6 or 7 months after completing curative-intent therapy. And he was actually quite symptomatic from the disease, especially at the neck. DR LOVE: Did he have metastatic disease? DR COHEN: And he had metastatic disease. DR LOVE: Where? DR COHEN: He had a renal lesion that we biopsied and confirmed squamous cell carcinoma, and he had lung metastases. So he had fairly extensive disease that was not only symptomatology but also growing. And so we decided to definitely treat him with therapy. And we had the option on a clinical trial to treat him with afatinib. DR LOVE: What would you have been thinking off study? DR COHEN: Off study for this patient, we would have still been thinking single-agent therapy. This was a patient who had been smoking for a long time and, in fact, was continuing to smoke and unfortunately had some of the comorbidities associated with long-term tobacco exposure. So he clearly had COPD. He had borderline cardiac function. He had enough of an ejection fraction to allow us to treat him, but he had coronary artery disease. And so this was probably a patient who wasn’t going to be robust enough for certainly the EXTREME regimen and even questionable about doublet chemotherapy. DR LOVE: How old was he? DR COHEN: He was only 55. DR LOVE: Hmm. So what happened? DR COHEN: So we treated him with afatinib. And although he didn’t achieve a RECIST-defined response, he had clear shrinkage. He had, as I said, a lesion that was visible in the neck, and this was beginning to ulcerate. And then, upon afatinib, it actually shrank a little bit. We could see this visibly. The ulceration began to heal a little bit. So there was clear evidence, clinically, of benefit. He did have tumor shrinkage on his CT scans, but not enough to define a RECIST response. And he was on therapy for about 6 months and then, unfortunately, began to progress after that. DR LOVE: How did he tolerate the drug? DR COHEN: He had some of the typical side effects, diarrhea being the most prominent one. But he was able to tolerate the drug fairly well. On that clinical trial, the dose of afatinib was a little bit higher than the one that’s approved. We were using 50 mg as opposed to the approved dose of 40 mg. We ended up having to dose reduce him to 40 mg, but then he stayed on 40 mg. DR LOVE: What other problems, if any, did he have besides the diarrhea? DR COHEN: He did have the skin rash, the typical EGFR inhibitor type of skin rash, but it was the diarrhea that required dose reduction. The skin rash was something he could tolerate fairly well. |