Comparative analysis of overall survival using propensity score between first- and second-generation EGFR-TKI: Real world data of 1354 patients with EGFR mutant NSCLC

Ito, Kentaro; Murotani, Kenta; Kubo, Akihito; Kunii, Eiji; Taniguchi, Hirokazu; Shindo, Jo; Asada, Kazuhiro; Imaizumi, Kazuyoshi; Tanaka, Kenji F.; Inui, Naoki; Okuno, M.; Hataji, Osamu; Hayai, S.; Abe, Takashi; Kimura, Tomoki; Tsuda, Takeshi; Yamaguchi, Teppei; Oya, Yuko; Yoshida, Toru; Hida, Toyoaki

doi:10.1093/annonc/mdy292.077

Cited by 8 publications

(8 citation statements)

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“…TTF, defined as the time from the first dose to the last dose of treatment, is synonymous to time on treatment as reported here. In a Japanese chart review, analysis of data from approximately 1300 patients with EGFR mutation-positive NSCLC who received EGFR-TKI therapy showed longer TTF with afatinib (14.1 months) compared with erlotinib (10.6 months) or gefitinib (10.6 months) [57]; there was also a trend towards OS benefit. In data from two retrospective, observational multicenter studies (the GioTag study and the RealGiDo study), time on treatment with afatinib was 11.9 months (90% CI: 10.9-12.2) [58] and 18.7 months (95% CI: 15.1-21.5) [59], respectively.…”

Section: Discussionmentioning

confidence: 99%

Duration of treatment among patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive non-small-cell lung cancer in the USA

et al. 2019

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Aim: Evaluate duration of therapy among patients treated with afatinib or erlotinib as first-line therapy for non-small-cell lung cancer (NSCLC). Materials & methods: NSCLC patients initiating afatinib or erlotinib between 2014 and 2017 were identified in three large claims databases in the USA. Propensity score matching was conducted to compare the duration of treatment between patients by treatment. Results: Patients prescribed afatinib had a significantly longer median duration of treatment compared with those prescribed erlotinib (12.1 vs 9.9 months; p = 0.035) and experienced a 14% reduction in risk of discontinuing therapy (adjusted hazard ratio: 0.86; CI: 0.75–0.99). Conclusion: First-line treatment duration in a real-world setting was significantly longer for patients prescribed afatinib compared with erlotinib.

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Section: Discussionmentioning

confidence: 99%

Duration of treatment among patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive non-small-cell lung cancer in the USA

et al. 2019

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“…Although there are no head-to-head data, PFS attained with afatinib in the Japanese subanalysis of LUX-Lung 3 suggests that afatinib could possibly be more effective than first-generation TKIs in Japanese patients. Indeed, a number of real-world studies support this possibility, especially in patients with Del19 mutations [43,44].…”

Section: Second-generation Egfr Tkis (Erbb Family Blockers) In Asian and Non-asian Populationsmentioning

confidence: 96%

Egfr Tyrosine Kinase Inhibitors for EGFR Mutation-Positive Non-Small-Cell Lung Cancer: Outcomes in Asian Populations

Kim

Melosky²,

Park

et al. 2021

Future Oncol.

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Few data are available that have compared outcomes with different EGFR tyrosine kinase inhibitors (TKIs) specifically in Asian patients with EGFR mutation-positive non-small-cell lung cancer. In this narrative review, we have collated available data from prospective studies that have assessed first-, second- and third-generation EGFR TKIs in Asian populations, including subanalyses in individual countries (China and Japan). These data indicate that outcomes with first- and second-generation TKIs are broadly similar in Asian and non-Asian populations. However, while the third-generation EGFR TKI, osimertinib, confers significant overall survival benefit over erlotinib/gefitinib in non-Asians, this is not apparent in Asians, particularly in countries like Japan with well-resourced healthcare. Head-to-head comparisons of second- and third-generation EGFR TKIs, with OS as a primary end point, should be considered in Asia.

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“…Several real-world studies conducted in Asian countries have compared clinical outcomes with afatinib versus first-generation EGFR TKIs in EGFR mutation-positive NSCLC, including studies conducted in Japan [ 28 , 29 ], South Korea [ 30 ], and Taiwan [ 31 – 34 ] (Table 1 ). Key clinical outcomes [PFS, overall survival (OS), time to treatment failure (TTF)] were numerically, and, in many cases, significantly, greater with afatinib than with gefitinib and/or erlotinib across these comparative studies [ 28 – 31 , 33 , 34 ].…”

Section: Real-world Evidence For the Effectiveness Of Afatinibmentioning

confidence: 99%

Afatinib as First-Line Treatment in Asian Patients with EGFR Mutation-Positive NSCLC: A Narrative Review of Real-World Evidence

et al. 2021

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Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) are a standard of care in the first-line treatment of patients with EGFR mutation-positive metastatic non-smallcell lung cancer (NSCLC). EGFR mutations are relatively common in Asian patients with NSCLC, and there is an increasing number of studies supporting the effectiveness of the second-generation TKI afatinib in routine clinical practice in Asia. This article reviews these realworld studies investigating afatinib as first-line treatment for EGFR mutation-positive NSCLC in Asian patients. Evidence from real-world studies with afatinib in this patient population supports findings from randomized controlled trials (RCTs) showing that afatinib is associated with more favorable outcomes compared with the first-generation EGFR TKIs. The effectiveness of afatinib has also been shown in realworld studies in Asian patients with poor prognostic factors, who are often under-represented or excluded from RCTs, such as those with uncommon EGFR mutations, brain metastases, or poor performance status, and elderly patients. The tolerability profile of afatinib in the real-world setting reflects that seen in RCTs, with no new safety signals reported in realworld studies in Asian patients with EGFR mutation-positive NSCLC. Dose-modification strategies also seem to be effective in the real world, with results of the RealGido study, which included 44% Asian patients, confirming findings from prospective clinical trials showing that tolerability-guided afatinib dose modifications can reduce the incidence of adverse events without adversely affecting clinical outcomes. While further research, including clinical trial data, is needed, real-world data have also demonstrated the feasibility of sequential afatinib followed by the third-generation TKI osimertinib in T790M-positive EGFR mutationpositive patients, which showed longer overall survival. Together, these real-world results demonstrate the real-world clinical effectiveness of afatinib as first-line treatment for patients with EGFR mutation-positive NSCLC.

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Comparative analysis of overall survival using propensity score between first- and second-generation EGFR-TKI: Real world data of 1354 patients with EGFR mutant NSCLC

Cited by 8 publications

References 0 publications

Duration of treatment among patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive non-small-cell lung cancer in the USA

Duration of treatment among patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive non-small-cell lung cancer in the USA

Egfr Tyrosine Kinase Inhibitors for EGFR Mutation-Positive Non-Small-Cell Lung Cancer: Outcomes in Asian Populations

Afatinib as First-Line Treatment in Asian Patients with EGFR Mutation-Positive NSCLC: A Narrative Review of Real-World Evidence

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