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

Abstract

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.

Real‐world treatment patterns of metastatic non‐small cell lung cancer patients receiving epidermal growth factor receptor tyrosine kinase inhibitors

“…This retrospective study using real‐world US claims data investigated a total of 2505 mNSCLC patients newly initiating 1L EGFR TKIs and described key patient characteristics and treatment patterns. Median ages of patients were similar across all three cohorts and the patients were predominantly female, which is consistent with the populations reported in other real‐world studies for 1L EGFR TKI use 11–13 and with the prevalence of EGFR mutations in women 22 …”

“…Other retrospective database studies conducted using US claims data have reported similar median 1L treatment durations for first‐ and second‐generation EGFR TKIs, including 7.7–8.2 months for a combined cohort of EGFR TKIs 13 and 9.9 months for erlotinib and 12.1 months for afatinib. 12 Furthermore, time to treatment discontinuation has previously been shown to be a proxy for PFS 23 and we indeed found that the median durations of first‐ and second‐generation EGFR TKI treatments in this study were comparable to the median PFS reported in their respective clinical trials (9.7–13.3 months 3 , 24 , 25 for erlotinib and 11.0–11.1 months 26 , 27 , 28 for afatinib), as well as the median PFS for first‐generation EGFR TKIs reported in the phase III FLAURA trial (10.2 months). 29 Lastly, the median duration of 1L osimertinib treatment in our cohort was similar to the median PFS reported in the FLAURA trial and a recent prospective, observational, real‐world study of nine Italian oncology centers (18.9 months in both studies).…”

“…9,10 Consequently, osimertinib is the preferred 1L EGFR TKI as per the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) in EGFRm mNSCLC. 1 There is published real world data on first-and secondgeneration EGFR TKIs [11][12][13] ; however, there is no published data on the real-world use of 1L osimertinib in comparison to other EGFR TKIs. Hence, this retrospective database analysis of mNSCLC patients was conducted to understand treatment patterns in patients treated with EGFR TKIs in the 1L setting, including type and duration of 1L treatment and second-line (2L) treatments.…”

Healthcare resource utilization and costs associated with patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive NSCLC in the United States

“…Databases used for this study included Truven MarketScan (spanning January 1, 2013-March 31, 2017) 10 , IMS PharMetrics Plus (spanning January 1, 2013-September 30, 2017) 11 and Optum Clinformatics Data Mart (spanning January 1, 2013-September 30, 2017) 12 . Full details of databases included in this analysis have been reported in full previously; algorithms used information on age, sex, US region, hospital admission date, discharge date, and primary discharge diagnosis to remove duplicate information, and only the most complete records were retained for analysis 9 . Ethics committee approval was not required for this study.…”

“…Evidence suggests that second-generation EGFR TKIs may be more effective than first-generation TKIs as first-line treatment in EGFR mutation-positive NSCLC [6][7][8] , although no randomized, controlled clinical trials have been conducted that have directly compared afatinib with erlotinib in this setting. To address this gap, and to provide insights into the comparative effectiveness of afatinib and erlotinib, a realworld study was undertaken using data from three administrative claims databases in the US 9 . Results showed that patients prescribed afatinib had a significantly longer median duration of treatment compared to those prescribed erlotinib (12.1 vs 9.9 months, p ¼ 0.035) and experienced a 14% reduction in risk of discontinuing therapy (adjusted hazard ratio ¼ 0.86, confidence interval ¼ 0.75-0.99).…”