LUN-CHE CHENJIN-YUAN SHIHCHONG-JEN YUYang C.-Y.2020-08-132020-08-1320192051-3380https://www.scopus.com/inward/record.uri?eid=2-s2.0-85065498754&doi=10.1002%2frcr2.425&partnerID=40&md5=8b23718132292101f19e41007b38f1dchttps://scholars.lib.ntu.edu.tw/handle/123456789/512585Uncommon mutations account for 10–15% of epidermal growth factor receptor (EGFR) mutations in patients with non-small-cell lung cancer. Afatinib is currently the most efficient EGFR-tyrosine kinase inhibitor (TKI) against uncommon EGFR mutations. Here we report a 56-year-old woman presenting with persistent cough for one month. She was diagnosed with stage IV lung adenocarcinoma by bronchoscopic biopsy to the left lower lung tumour and serial image modalities. A rare H773L/V774M compound mutation in exon 20 was detected by gene sequencing. The patient received first-line afatinib but primary resistance was noted with rapid left lower lung tumour progression. Second-line chemotherapy combined with bevacizumab, pemetrexed, and cisplatin demonstrated more durable response. Our case suggests that H773L/V774M may be one of the EGFR-TKI-resistant uncommon EGFR mutations. ? 2019 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology[SDGs]SDG3afatinib; bevacizumab; cisplatin; docetaxel; epidermal growth factor receptor; pemetrexed; protein tyrosine kinase inhibitor; ramucirumab; adaptive immunity; adrenal gland; adult; Article; biopsy; bronchoscopy; case report; clinical article; coughing; disease exacerbation; DNA extraction; evaluation and follow up; exon; female; gene mutation; gene sequence; human; lung adenocarcinoma; lung metastasis; mediastinum lymph node; middle aged; multiple cycle treatment; non small cell lung cancer; radiation dose; supraclavicular lymph node; tumor growth; whole brain radiotherapyjournal article10.1002/rcr2.4252-s2.0-85065498754