Open Journal Systems

Successful afatinib treatment through nasogastric tube in a ventilated patient with non-small cell lung cancer

Takahiro Karasuno ()
Nobuko Nishiura ()
Hiroyuki Takamori ()
Ken Kodama ()


The majority of lung cancer patients are discovered at advanced stages and some of them may often have complex medical problems in addition to the diagnosis of cancer, such as oncologic emergency requiring assistance in an intensive care unit (ICU). In the last decade, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have been recognized as key drugs for non-small cell lung cancer (NSCLC) harboring sensitive EGFR mutation. We report a case of stage IV NSCLC with EGFR mutation (exon 19 deletion). He was in a life-threatening stage due to a massive intrathoracic hemorrhage. After chest tube drainage and mechanical ventilation, afatinib was administered through nasogastric tube. Consequently, a dramatic response was obtained and he was able to be discharged from our hospital 11 weeks after the initiation of afatinib. This approach may be of benefit to rescue from life-threatening condition for selected patients.


afatinib; non-small cell lung cancer; EGFR mutation; intensive care unit; mechanical ventilation; water-dispersion type

Full Text:



Adam AK, Soubani AO. Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit. Eur Respir J 2008; 31(1): 47–53. doi: 10.1183/09031936.00031607.

Roques S, Parrot A, Lavole A, Ancel PY, Gounant V, et al. Six-month prognosis of patients with lung cancer admitted to the intensive care unit. Intensive Care Med 2009; 35(12): 2044–2050. doi: 10.1007/s00134-009-1625-y.

Soubani AO, Ruckdeschel JC. The outcome of medical intensive care for lung cancer patients: The case for optimism. J Thorac Oncol 2011; 6(3): 633–638. doi: 10.1097/JTO.0b013e318200f9eb.

Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med 2010; 362(25): 2380–2388. doi: 10.1056/NEJMoa0909530.

Zhou C, Wu YL, Chen G, Feng J, Liu XQ, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small cell lung cancer (OPTIMAL, CTONG-0802): A multicentre, open-label, randomised, phase 3 study. Lancet Oncol 2011; 12(8): 735–742. doi: 10.1016/S1470-2045(11)70184-X.

Sequist LV, Yang JC, Yamamoto N, O’Byrne K, Hirsh V, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol 2013; 31(27): 3327–3334. doi: 10.1200/JCO.2012.44.2806.

Suzumura T, Yonesaka K, Tsukuda H, Fukuoka M. Successful gefitinib treatment administration via gastrostomy tube in a patient with non-small cell lung cancer with dysphagia. BMJ Case Rep 2014; March 13. doi: 10.1136/bcr-2013-202705.

Tamai K, Nagata K, Otsuka K, Nakagawa A, Tachikawa R, et al. Crizotinib administered via nasogastric and percutaneous endoscopic gastrostomy tubes for the successful treatment of ALK-rearranged lung cancer in a patient with poor performance status. Respir Investig 2013; 51(1): 46–48. doi: 10.1016/j.resinv.2012.12.001.

Cantarini MV, McFarquhar T, Smith RP, Bailey C, Marshall AL. Relative bioavailability and safety profile of gefitinib administered as a tablet or as a dispersion preparation via drink or nasogastric tube: Results of a randomized, open-label, three-period crossover study in healthy volunteers. Clin Ther 2004; 26(10): 1630–1636. doi: 10.1016/j.clinthera.2004.10.011.

Reck M, Popat S, Reinmuth N, De Ruysscher D, Kerr KM, et al. Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25(Suppl 3): iii27–39. doi: 10.1093/annonc/mdu199.

Langer CJ. The “lazarus response” in treatment-naive, poor performance status patients with non-small-cell lung cancer and epidermal growth factor receptor mutation. J Clin Oncol 2009; 27(9): 1350–1354. doi: 10.1200/JCO.2008.20.4859.

Bosch-Barrera J, Sais E, Lorencio C, Porta R, Izquierdo A, et al. Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma. Lung Cancer 2014; 86(1): 102–104. doi: 10.1016/j.lungcan.2014.07.010.

Li D, Ambrogio L, Shimamura T, Kubo S, Takahashi M, et al. BIBW2992, an irreversible EGFR/HER2 inhibitor highly effective in preclinical lung cancer models. Oncogene 2008; 27(34): 4702–4711. doi: 10.1038/onc.2008.109.

Banno E, Togashi Y, Kobayashi Y, Hayashi H, Mitsudomi T, et al. Afatinib is especially effective against non-small cell lung cancer carrying an EGFR exon 19 deletion. Anticancer Res 2015; 35(4): 2005–2008.

Yang JC, Wu YL, Schuler M, Sebastian M, Popat S, et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): Analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 2015; 16(2): 141–151. doi: 10.1016/S1470-2045(14)71173-8.

Hoffknecht P, Tufman A, Wehler T, Pelzer T, Wiewrodt R, et al. Efficacy of the irreversible ErbB family blocker afatinib in epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)-pretreated non-small-cell lung cancer patients with brain metastasis or leptomeningeal disease. J Thorac Oncol 2015; 10(1): 156–163. doi: 10.1097/JTO.0000000000000380.

Wu YL, Zhou C, Hu CP, Feng J, Lu S, et al. Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-Lung 6): An open-label, randomised phase 3 trial. Lancet Oncol 2014; 15(2): 213–222. doi: 10.1016/S1470-2045(13)70604-1.

Miller VA, Hirsh V, Cadranel J, Chen YM, Park K, et al. Afatinib versus placebo for patients with advanced, metastatic non-small-cell lung cancer after failure of erlotinib, gefitinib, or both, and one or two lines of chemotherapy (LUX-Lung 1): A phase 2b/3 randomised trial. Lancet Oncol 2012; 13(5): 528–538. doi: 10.1016/S1470-2045(12)70087-6.

Seto T, Kiura K, Nishio M, Nakagawa K, Maemondo M, et al. CH5424802 (RO5424802) for patients with ALK-rearranged advanced non-small-cell lung cancer (AF-001JP study): A single-arm, open-label, phase 1-2 study. Lancet Oncol 2013; 14(7): 590–598 doi: 10.1016/S1470-2045(13)70142-6.

Solomon BJ, Mok T, Kim DW, Wu YL, Nakagawa K, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med 2014; 371(23): 2167–2177. doi: 10.1056/NEJMx150034.



  • There are currently no refbacks.

Copyright (c) 2018 Takahiro Karasuno, Nobuko Nishiura, Hiroyuki Takamori, Ken Kodama

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.