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WHAT IS THIS SUMMARY ABOUT? Afatinib can be used as a treatment for people with metastatic squamous cell carcinoma (shortened to SqCC) of the lung, after they have been treated with chemotherapy. Nowadays, people with SqCC are treated with medicines other than chemotherapy alone first, such as pembrolizumab combined with chemotherapy. The authors of this article wanted to know whether afatinib works well and is safe to take as a follow-up treatment after initial treatment with pembrolizumab plus chemotherapy was stopped because it was no longer effective, caused too many side effects, or for other reasons. This 'real-world' study focused on how long people were treated with afatinib or chemotherapy as follow-up treatment, and whether they had any side effects. It is called a real-world study because it looks at the treatments people received as part of their everyday treatment in the clinic. This is different from a randomized controlled trial in which people with similar characteristics are randomly assigned to receive different treatments so that those treatments can be compared. WHAT WERE THE RESULTS? After initial treatment with pembrolizumab plus chemotherapy, people receiving follow-up treatment with afatinib continued taking the drug for about 7 months on average, which is similar to what researchers expected. People who were treated with chemotherapy instead of afatinib as follow-up treatment stayed on treatment for about 4 months. People treated with afatinib had side effects that could be managed, without too many severe side effects linked to the immune system. WHAT DO RESULTS OF THE STUDY MEAN? The length of time people stay on treatment is important because treatment is generally stopped if the cancer progresses or if side effects become too hard to tolerate. Therefore, a longer time on treatment suggests it is working against the cancer without causing too many side effects. Overall, this study shows that afatinib could be an option for people who have already been treated for metastatic SqCC with pembrolizumab plus chemotherapy.