Multi-disciplinary proactive follow-up algorithm for patients with advanced NSCLC receiving afatinib

Cheema, Parneet K.; Thawer, Alia; Leake, J.; Cheng, Susanna; Khanna, Suneil; Victor, J. Charles

doi:10.1007/s00520-018-4392-x

Cited by 5 publications

(1 citation statement)

References 34 publications

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“…According to the label, the recommended initial dose of afatinib is 40 mg, which can be reduced by 10 mg if not tolerated ( Afatinib label, 2019 ). In clinical trials, the proportion of patients with dose reduction is 28–53% ( Sequist et al, 2013 ; Wu et al, 2014 ), and more than half of the patients undergo dose modification due to adverse reactions in real-world studies ( Kim et al, 2017 ; Cheema et al, 2019 ). It is an important clinical issue, but whether dose reduction can reduce the incidence of adverse reactions and achieve similar clinical effectiveness simultaneously remains elusive.…”

Section: Introductionmentioning

confidence: 99%

Impact of Dose Reduction of Afatinib Used in Patients With Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Wang

Chen

et al. 2021

Front. Pharmacol.

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Background and Aim: As one of the second-generation epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitors, afatinib brings survival benefits to patients with common and rare EGFR mutations. This study aimed to compare the effectiveness and safety of 30 and 40 mg of afatinib in patients with non–small cell lung cancer (NSCLC) using qualitative and quantitative analysis methods so as to provide reference for clinical medication.Methods: The PubMed, Embase, ClinicalTrials.gov, Cochrane Library, China National Knowledge Infrastructure, and WanFang databases were thoroughly searched from inception to February 26, 2021. Two researchers independently screened the literature, extracted data, and evaluated the quality. RevMan and Stata 15.0 were used for meta-analysis.Results: Twelve cohort studies including 1290 patients for final analysis were selected; of which, 1129 patients were analyzed to measure the effectiveness outcomes and 470 patients were analyzed for safety outcomes. In patients with non-brain metastasis, the progression-free survival of the first- or second-line treatment with reduced-dose afatinib was equivalent to the conventional dose. In terms of safety, the reduced dose could significantly lower the incidence of severe diarrhea and severe rash, but not the total incidence of diarrhea, rash, and all levels of paronychia.Conclusions: The incidence of common serious adverse reactions was significantly lower with 30 mg of afatinib than with 40 mg of afatinib in patients with NSCLC. The effectiveness appeared to be similar to that in patients with non-brain metastasis. This study provides a reference for clinical dose reduction of afatinib.Systematic Review Registration: [PROSPERO], identifier [CRD42021238043]

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