Madam S, who diagnosed to have stage IV lung adenocarcinoma with exon 21 L858R point mutation (T3N2M1a)
was admitted for massive pericardial effusion in April 2016. She was ECOG 4 on admission. Her ECOG improved
to 1 after pericardial tapping and initiation of free sample erlotinib 100 mg daily. Repeated CT thorax post treatment
showed the disease was partial responded. Due to financial constraints, she had never bought any EGFR-TKI. She
was given a free sample of erlotinib intermittently for total of 12 months followed by intermittent afatinib supply for
2 years. Due to this limited supply, she took half doses of afatinib by cutting a 40 mg tablet once every few days to
sustain the continuation of cancer treatment. No major side effects were observed and she remained ECOG 0 with
good weight gain. Up to her last clinic visit in September 2021, her PFS was more than 5 years. Intermittent doses of
EGFR-TKI may prolong PFS in patients with advanced EGFRm+ NSCLC who has limited treatment options.