Bevacizumab plus dacomitinib combination therapy for L858R‐mutated metastatic lung adenocarcinoma: A report of two cases

Dual inhibition of the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor pathways for the treatment for EGFR‐mutated, metastatic non‐small cell lung cancer is supported by previous randomized controlled trials. However, the use of second‐generation irreversible EGFR tyrosine kinase inhibitor (TKI) dacomitinib in combination with antiangiogenic therapy has not been reported in the literature. Here, we report the case of a 73‐year‐old man who presented with hemoptysis and dyspnea on exertion and was diagnosed with right upper lung adenocarcinoma with pleural metastasis and L858R mutation. The second case is of a 60‐year‐old woman who presented with low back pain and was diagnosed with right lower lung adenocarcinoma with bone metastasis and L858R mutation. Both patients underwent first‐line therapy with the TKI dacomitinib in combination with bevacizumab. The first patient showed a nearly complete response, and the second patient showed a partial response after the combination therapy and no severe side effects. Bevacizumab plus dacomitinib combination therapy enabled two patients with untreated NSCLC harboring L858R mutation of exon 21 to achieve a good response without obvious side effects, which might be recommended as first‐line therapy.