Real-life comparison of the afatinib and first-generation tyrosine kinase inhibitors in nonsmall cell lung cancer harboring EGFR exon 19 deletion: a Turk Oncology Group (TOG) study.

Adult Afatinib / administration & dosage Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols / therapeutic use Carcinoma, Non-Small-Cell Lung / drug therapy ErbB Receptors / genetics Erlotinib Hydrochloride / administration & dosage Exons Female Follow-Up Studies Gefitinib / administration & dosage Gene Deletion Humans Lung Neoplasms / drug therapy Male Middle Aged Neoplasm Metastasis Prognosis Protein Kinase Inhibitors / therapeutic use Retrospective Studies Survival Rate

Afatinib Erlotinib Exon 19 del Gefitinib NSCLC

Journal

Journal of cancer research and clinical oncology

ISSN: 1432-1335

Titre abrégé: J Cancer Res Clin Oncol

Pays: Germany

ID NLM: 7902060

Informations de publication

Date de publication:
Jul 2021

Historique:

received: 03 10 2020

accepted: 12 12 2020

pubmed: 13 1 2021

medline: 8 6 2021

entrez: 12 1 2021

Statut: ppublish

Résumé

The new second-generation tyrosine kinase inhibitors (TKIs) have superior survival outcome and worse toxicity profile when compared with first-generation TKIs according to the results of clinical trials. However, there are limited studies that investigate the efficacy and safety of the new generation TKIs in real-world patients. Thus, we aimed to compare the efficacy and safety of the afatinib, an irreversible inhibitor of ErbB family receptor, and first-generation TKIs in real-world patients. We included advanced nonsmall cell lung cancer (NSCLC) patients who had EGFR exon 19del mutation and treated with afatinib or first-generation TKIs as upfront treatment between 2016 and 2020. All patient's information was collected retrospectively. The study cohort was divided as afatinib arm and erlotinib/gefitinib arm. A total of 283 patients at the 24 oncology centers were included. The 89 and 193 of whom were treated with afatinib and erlotinib/gefitinib, respectively. After 12.9 months (mo) of follow-up, the median PFS was statistically longer in the afatinib arm than erlotinib/gefitinib arm (19.3 mo vs. 11.9 mo, p: 0.046) and the survival advantage was more profound in younger patients (< 65 years). The 24-mo overall survival rate was 76.1% and 49.5% in the afatinib arm and erlotinib/gefitinib arm, respectively. Although all-grade adverse event (AE) rates were similar between the two arms, grade 3-4 AE rates were higher in the afatinib arm (30.7% vs. 15.2%; p: 0.004). In our real-world study, afatinib has superior survival outcomes despite worse toxicity profile as inconsistent with clinical study results and it is the good upfront treatment option for younger patients and elderly patients who have good performance status.

Sections du résumé

BACKGROUND BACKGROUND

MATERIALS AND METHODS METHODS

We included advanced nonsmall cell lung cancer (NSCLC) patients who had EGFR exon 19del mutation and treated with afatinib or first-generation TKIs as upfront treatment between 2016 and 2020. All patient's information was collected retrospectively. The study cohort was divided as afatinib arm and erlotinib/gefitinib arm.

RESULTS RESULTS

A total of 283 patients at the 24 oncology centers were included. The 89 and 193 of whom were treated with afatinib and erlotinib/gefitinib, respectively. After 12.9 months (mo) of follow-up, the median PFS was statistically longer in the afatinib arm than erlotinib/gefitinib arm (19.3 mo vs. 11.9 mo, p: 0.046) and the survival advantage was more profound in younger patients (< 65 years). The 24-mo overall survival rate was 76.1% and 49.5% in the afatinib arm and erlotinib/gefitinib arm, respectively. Although all-grade adverse event (AE) rates were similar between the two arms, grade 3-4 AE rates were higher in the afatinib arm (30.7% vs. 15.2%; p: 0.004).

DISCUSSION CONCLUSIONS

In our real-world study, afatinib has superior survival outcomes despite worse toxicity profile as inconsistent with clinical study results and it is the good upfront treatment option for younger patients and elderly patients who have good performance status.

Identifiants

DOI: 10.1007/s00432-020-03501-6 PMID: 33433657

pubmed: 33433657

doi: 10.1007/s00432-020-03501-6

pii: 10.1007/s00432-020-03501-6

doi:

Substances chimiques

Protein Kinase Inhibitors 0

Afatinib 41UD74L59M

Erlotinib Hydrochloride DA87705X9K

EGFR protein, human EC 2.7.10.1

ErbB Receptors EC 2.7.10.1

Gefitinib S65743JHBS

Types de publication

Comparative Study Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

2145-2152

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