Real-world experience of afatinib as first-line therapy for advanced EGFR mutation-positive non-small cell lung cancer in Korea

Lee, Sung Yong; Choi, Chang‐Min; Chang, Yoon Soo; Lee, Kye Young; Kim, Seung Joon; Yang, Sei Hoon; Ryu, Jeong Seon; Lee, Jeong Eun; Lee, Shin Yup; Park, Ji Young; Kim, Young‐Chul; Oh, Il‐Seok; Jung, Chi Young; Lee, Sang Hoon; Yoon, Seong Hoon; Choi, Juwhan; Jang, Tae Won

doi:10.21037/tlcr-21-501

Cited by 13 publications

(28 citation statements)

References 45 publications

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“…A retrospective multicenter study also showed that afatinib was effective in patients with compound mutations (median time of treatment: 12.3 months, 95% CI: 7.7–17.0 months; median OS: 29.1 months, 95% CI: 20.4–37.7 months) and in patients with major uncommon mutations (G719X and L861Q) (median time of treatment: 20.3 months, 95% CI: 15.1–25.5 months; median OS: 30.6 months, 95% CI: 26.3–34.8 months), but not in patients harboring drug-resistant mutations (ex20ins, S768I, T790M) (median time of treatment: 3.8 months, 95% CI: 1.7–6.0 months; median OS: 8.5 months, 95% CI: 5.2–11.7 months) [23] . In addition, real-world data showed that afatinib reached an ORR of 100% in four patients with advanced NSCLC with exon 18 and 21 mutations [24] . Tan et al [25] retrospectively found that afatinib was superior to gefitinib/erlotinib/icotinib for patients with advanced or recurrent NSCLC with atypical plus typical mutations (ORR: 100.0% vs .…”

Section: Egfr Compound Mutationsmentioning

confidence: 99%

“…[23] In addition, real-world data showed that afatinib reached an ORR of 100% in four patients with advanced NSCLC with exon 18 and 21 mutations. [24] Tan et al [25] retrospectively found that afatinib was superior to gefitinib/erlotinib/icotinib for patients with advanced or recurrent NSCLC with atypical plus typical mutations (ORR: 100.0% vs. 54.5%, P = 0.02; median PFS: not reached vs. 13.6 months, P = 0.03). These results indicated that afatinib could reduce heterogeneity and have a more extensive inhibitory profile than firstor thirdgeneration TKIs, which supports afatinib as a treatment option for EGFR compound mutations.…”

Section: Egfr Compound Mutationsmentioning

confidence: 99%

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Epidermal growth factor receptor compound and concomitant mutations: advances in precision treatment strategies

Bai

Guo

et al. 2023

Chinese Medical Journal

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Epidermal growth factor receptor (EGFR) mutations are common oncogenic driver mutations in patients with non-small cell lung cancer (NSCLC). The application of EGFR-tyrosine kinase inhibitors (TKIs) is beneficial for patients with advanced and early-stage NSCLC. With the development of next-generation sequencing technology, numerous patients have been found to have more than one genetic mutation in addition to a single EGFR mutation; however, the efficacy of conventional EGFR-TKIs and the optimal treatments for such patients remain largely unknown. Thus, we review the incidence, prognosis, and current treatment regimens of EGFR compound mutations and EGFR concomitant mutations to provide treatment recommendations and guidance for patients with these mutations.

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Section: Egfr Compound Mutationsmentioning

confidence: 99%

Section: Egfr Compound Mutationsmentioning

confidence: 99%

Epidermal growth factor receptor compound and concomitant mutations: advances in precision treatment strategies

Bai

Guo

et al. 2023

Chinese Medical Journal

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Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

“…Afatinib is a second-generation, irreversible EGFR-TKI, and its good CNS efficacy has been previously shown in several studies, where it was also superior to first-G EGFR-TKIs for brain metastasis [4,5,11]. Until now, however, the role of brain RT for baseline brain metastasis before afatinib therapy has not been evaluated.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

“…Brain metastasis is an important poor prognostic factor in patients with non-small cell lung cancer (NSCLC) [1]. The incidence of baseline brain metastasis is especially higher in epidermal growth factor receptor (EGFR)-mutant NSCLC than EGFR-wild type tumors [2,3], with rates ranging from 31%-41% in patients with EGFR-mutant NSCLC [3][4][5]. Therefore, the appropriate treatment for baseline brain metastasis has become an important decision-making step in the treatment of EGFR-mutant NSCLC.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Brain Radiotherapy before First-Line Afatinib Therapy, Compared to Gefitinib or Erlotinib, in Patients with EGFR-Mutant Non–Small Cell Lung Cancer

Jung¹,

Park²,

Lee³

et al. 2023

Cancer Res Treat

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Brain metastasis is common in patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) at initial presentation. A previous study showed that brain radiotherapy (RT) before first-generation (first-G) EGFR-tyrosine kinase inhibitor (TKI) therapy is associated with longer overall survival than TKI therapy alone. However, there is no data regarding the role of additional brain RT before afatinib therapy. Materials and MethodsBetween October 2014 and June 2019, EGFR-mutant NSCLC patients with brain metastases who started first-G EGFR-TKIs (gefitinib or erlotinib) or afatinib as first-line therapy were retrospectively analyzed. This study compared overall survival and intracranial progressionfree survival (PFS) between patients who received EGFR-TKIs alone and EGFR-TKIs with brain RT and either a first-G EGFR-TKI or afatinib, respectively. ResultsThe median follow-up duration was 29.6 months (range, 1.5-116.9 months). In the first-G EGFR-TKI group (n=155), 94 (60.6%) patients received the first-G EGFR-TKI alone and 61 (39.4%) patients received brain RT prior to their first-G EGFR-TKI. In the afatinib group (n=204), 126 (61.8%) patients received afatinib alone and 78 (38.2%) patients received brain RT prior to afatinib.There was no difference in overall survival rates between the groups with RT (35.6 months: 95% confidence interval [CI], 27.9%-43.3%) and without RT (31.4 months: 95% CI, 23.9%-38.9%) in the afatinib group (p=0.58), but there was a significant difference in overall survival in the first-G EGFR-TKI group in a manner favoring additional brain RT (41.1 months: 95% CI, 30.5%-51.7% vs. 25.8 months: 95% CI, 20.1%-31.5%; p=0.02). Meanwhile, median intracranial PFS was not different between patients who received EGFR-TKI therapy alone vs.

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Epidemiology and Outcomes of Non–Small Cell Lung Cancer in South Korea

Jung,

Lee,

Lim

et al. 2024

JAMA Netw Open

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ImportanceValuable evidence regarding clinical characteristics, treatments, and outcomes for non–small cell lung cancer (NSCLC) is limited to individual hospital databases or national-level registries. The common data and federated analysis framework developed through the Extensible Platform for Observational Research in Lung Cancer (EXPLORE-LC) initiative allows for research across multiple high-quality data sources, which may provide a deeper understanding of the NSCLC landscape and identification of unmet needs of subpopulations.ObjectiveTo describe clinical characteristics, initial treatment patterns, subsequent treatment, and overall survival (OS) of patients with NSCLC in South Korea.Design, Setting, and ParticipantsThis multicenter cohort study included patients aged 18 years and older who were diagnosed with NSCLC between 2014 and 2019 and followed up until March 2020 at 3 tertiary hospitals in South Korea. Clinical data were collected using a common data model and clinical data warehouse. Patients who had an initial diagnosis of nonsquamous (NSQ) or squamous (SQ) NSCLC and who had received at least 1 treatment for NSCLC were included in the study. Data were analyzed from June through November 2022.Main Outcomes and MeasuresThe primary outcome was clinical OS for patients with NSCLC. Secondary outcomes were clinical characteristics and treatment patterns subsequent to the diagnosis of NSCLC.ResultsAmong 22 101 patients with NSCLC who received anticancer treatment analyzed in this study, 17 350 patients (78.5%) had NSQ and 4751 patients (21.5%) had SQ NSCLC. Clinical characteristics and outcomes and treatment patterns were assessed for 13 084 patients with NSQ cancer who had known EGFR and ALK status (75.4%; mean [SD] 62.2 [10.5] years; 6552 males [50.1%]) and all 4751 patients with SQ cancer (mean [SD] age, 67.1 [8.6] years; 4427 males [93.2%]). More than half of patients with NSQ cancer were never smokers (7399 patients [56.6%]). Patients with SQ cancer were mostly males and former or current smokers (4235 patients [89.1%]) and were diagnosed at a later clinical stage than patients with NSQ cancer (eg, stage I: 1165 patients [24.5%] vs 5388 patients [41.2%]). Patients with EGFR-positive and ALK-positive NSQ cancer diagnosed between 2017 and 2019 had better median OS than similar patients diagnosed between 2014 and 2016 (EGFR-positive: not reached [95% CI, 35.9 months to not reached] vs 28.4 months [95% CI, 25.8 to 30.0 months]; P &lt; .001; ALK-positive: not reached [95% CI, not reached] vs 49.5 months [95% CI, 35.1 months to not reached]; P &lt; .001). No significant difference was observed in OS from first-line treatment for patients with SQ cancer.Conclusions and RelevanceThis study, which pooled medical data from multiple clinical data warehouses to produce a large study cohort, may provide meaningful insights into the clinical practice of NSCLC and underscores the value of a common data model approach. The analyzable dataset may hold great promise for future comprehensive identification of subpopulations and unmet needs.

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Real-world experience of afatinib as first-line therapy for advanced EGFR mutation-positive non-small cell lung cancer in Korea

Cited by 13 publications

References 45 publications

Epidermal growth factor receptor compound and concomitant mutations: advances in precision treatment strategies

Epidermal growth factor receptor compound and concomitant mutations: advances in precision treatment strategies

The Role of Brain Radiotherapy before First-Line Afatinib Therapy, Compared to Gefitinib or Erlotinib, in Patients with EGFR-Mutant Non–Small Cell Lung Cancer

Epidemiology and Outcomes of Non–Small Cell Lung Cancer in South Korea

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