We report the case of an 81‐year‐old patient who was referred to our center after a diagnosis of lung adenocarcinoma...EGFR mutational analysis revealed concomitant G719S exon 18 and S768I exon 20 mutations….In the same month, the recurrence of severe skin toxicity necessitated a further afatinib dose reduction to 20 mg per day....our patient did not progress precociously after commencing afatinib.