Supplementary Material for: Recurrent TAPO with Long-term Afatinib: A Case Report

Afatinib is the second generation EGFR-TKI. Recently, transient asymptomatic pulmonary opacity (TAPO) was reported in EGFR-mutation harboring NSCLC receiving osimertinib. However, TAPO related to other EGFR-TKI has not been reported. Here, we reported a case of TAPO related to afatinib in lung adenocarcinoma harboring EGFR mutation. A 64-year-old male had the diagnosis of stage IV (The 7th edition of the staging system by Union for International Cancer Control) lung adenocarcinoma habering EGFR del 19 mutation. He received afatinib 40mg per day from May, 2015. Partial response was achieved, though the dose was reduced to 30mg per day due to grade 3 rash. In January 2016, CT showed ground glass opacity in the right middle lobe, which resolved spontaneously two weeks later. He had no symptom and laboratory findings were not remarkable. Thereafter, recurrent GGO were revealed with chest CT, but all opacity improved without any medication (ie corticosteroids) or stopping afatinib. Therefore, we diagnosed a series of opacity as recurrent TAPO with afatinib. TAPO could occur with EGFR-TKI other than osimertinib. Further study is needed to establish the management of new opacity suggesting TAPO under EGFR-TKI treatment.