Despite concerted efforts that have been made to characterize and understand the genomic landscape of
gastric cancer (GC), only HER2 has been validated as a molecular target for GC treatment. Identifying new valid therapeutic targets is important for the treatment of this disease. The present report describes a Chinese male with a history of smoking two packs per day, who did not have a family history of
cancer or other
hereditary diseases, we discovered a small painless lump in the right groin in February 2018. Histopathology revealed a primary gastric
adenocarcinoma. Positron emission tomography-computed tomography (PET-CT) showed multiple hypermetabolic nodules in the right upper lung, greater curvature of the stomach, and muscles. The patient had received treatment included
oxaliplatin,
docetaxel, and
tegafur for two cycles, and second-line
therapy of
irinotecan and
capecitabine, inguinal mass excision followed by concurrent radio-
chemotherapy. However, the disease rapidly progressed. Whole exome sequencing (WES) showed uncommon
epidermal growth factor receptor (EGFR) mutation of G719S + L861Q. The following EGFR
tyrosine kinase inhibitors (TKIs)
afatinib demonstrated partial response. Two months after targeted
therapy, gastroscopy indicated rapid progression. With subsequent gastric specimen WES analysis, secondary MET amplification was found. The patient received local
radiotherapy for gastric lesions as well as
oral administration of
apatinib. However, the disease rapidly progressed. A month later, he died of
hepatic encephalopathy caused by
obstructive jaundice combined with pulmonary and biliary tract
infection. The present study indicated that
afatinib might be a beneficial therapeutic option for a subset of GC patients with rare EGFR mutation in their
tumors.