A 55 year-old man who has never smoked was diagnosed with stage IV lung adenocarcinoma….a third spinal decompression at T3 to T5 provided tissue for multiplexed mass spectrometry genotyping (OncoCarta™ version 1.0), which revealed a HER2 mutation in exon 20 with 12 base pair insertion (NM_004448.3: c. 2325_2326ins12, p.A775_G776insYVMA)....he started afatinib 40mg daily and achieved a clinical and radiologic response after 2 months...He tolerated afatinib well for a total of 10 months before PD.