The results of treatment in advanced stage non-small cell lung cancer patients with EGFR mutations by afatinib

  • Nguyễn Minh Hải 108 Military Central Hospital
  • Phạm Văn Luận 108 Military Central Hospital
  • Nguyễn Đình Tiến 108 Military Central Hospital
  • Đào Duy Tuyên 108 Military Central Hospital

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Keywords

Non-small cell lung cancer, EGFR mutations, afatinib first line

Abstract

Objective: To evaluate the result of afatinib as a first line therapy in advanced stage non-small cell lung cancer patients who have EGFR mutations positive. Subject and method: This was a prospective study, 41 patients with advanced stage non-small cell lung cancer with EGFR positive mutations were treated by afatinib as a first line treatment, they were followed and evaluated every 3 months or when they have symptoms of progressive disease. The main endpoints were the Objective Response Rate (ORR) and Progression-Free Survival (PFS), the secondary endpoints were Overall survival (OS) and adverse events. Result: The ORR was 92.6%, the median PFS was 14 months, and the median OS was 20 months. The estimated 1-year and 2-year OS rates were 93.3% and 39.1%, respectively. Median PFS in patients without brain metastases was 14 months, longer than in patients with brain metastases (12 months), p>0.05. Median PFS in patients harboring activating EGFR mutations was 14 months, longer than in patients with uncommon mutations (11 months), p>0.05; Median OS in patients carrying the exon 19 deletion mutation was 32 months, longer than the median OS in patients with EGFR mutation of L858R and uncommon mutations at 20 months and 17 months, respectively, p>0.05. Adverse effects were seen in 82.9% of patients, mainly rash (80.5%), but all of them were grade 1, grade 2. 5% of patients had grade 3 diarrhea. Conclusion: Afatinib was an effective option to treatment in patients with advanced stage non-small cell lung cancer with EGFR mutations. Especially, overall survival tended to be longer in patients carrying exon 19 deletion mutation compare L858R mutation and uncommon mutations.

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References

1. NCCN Guideline Insights. Non-Small Cell Lung Cancer, version 3.2022, feature updates to the NCCN Guidelines.
2. Sequist LV, Yang JC, Yamamoto N et al (2013) Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol 31: 3327-3334.
3. Wu YL, Zhou C, Hu CP et al (2014) Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-Lung 6): an open-label, randomised phase 3 trial. Lancet Oncol 15: 213-222.
4. Liang SK, Hsieh MS, Lee MR et al (2017) Real-world experience of afatinib as a first-line therapy for advanced EGFR mutation positive lung adenocarcinoma. Oncotarget 8(52): 90430-90443.
5. Su PL, Chen CW, Wu YL et al (2021) First-line treatment with irreversible tyrosine kinase inhibitors associated with longer OS in EGFR mutation positive non-small cell lung cancer. Thoracic Cancer 12: 287-296.
6. Kim Y, Lee SH, Ahn JS et al (2019) Efficacy and safety of afatinib for EGFR-mutant non-small cell lung cancer, compared with gefitinib or erlotinib. Cancer Res Treat 51: 502-509.
7. Shen YC, Tseng GC, Tu CY et al (2017) Comparing the effects of afatinib with gefitinib or Erlotinib in patients with advanced-stage lung adenocarcinoma harboring non-classical epidermal growth factor receptor mutations. Lung Cancer 110: 56-62.
8. Tu CY, Chen CM, Liao WC et al (2018) Comparison of the effects of the three major tyrosine kinase inhibitors as first-line therapy for non-small-cell lung cancer harboring epidermal growth factor receptor mutations, Oncotarget 9(36): 24237- 24247.
9. Trịnh Lê Huy, Trần Đình Anh (2022) Đánh giá hiệu quả điều trị bước 1 ung thư phổi không tế bào nhỏ giai đoạn muộn có đột biến gen EGFR bằng afatinib. Tạp chí Nghiên cứu Y học 155(7): 75-83.
10. Thanh Ha Vu, Hoa Thai Thi Nguyen, Linh Khanh Dao et al (2021) Effectiveness and tolerability of first-line afatinib for advanced EGFR-mutant non-small cell lung cancer in vietnam. Asian Pac J Cancer Prev 22 (5): 1581-1590.
11. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Can 45: 228-247.
12. National Cancer Institute, Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 Published: May 28, 2009 (v4.03: June 14, 2010).
13. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6): 649-655.
14. Park K, Tan EH, O’Byrne K et al (2016) Afatinib versus gefitinib as first-line treatment of patients with EGFR mutation-positive non-small-cell lung cancer (LUX-Lung 7): A phase 2B, open-label, randomised controlled trial. Lancet Oncol 17: 577-589.
15. Ho GF, Chai CS, Alip A et al (2019) Real-world experience of first-line afatinib in patients with EGFR-mutant advanced NSCLC: A multicenter observational study. BMC Cancer 19: 896.
16. Yang JC, Sequist LV, Geater SL et al (2015) Clinical activity of afatinib in patients with advanced non-small-cell lung cancer harbouring uncommon EGFR mutations: A combined post-hoc analysis of LUX-Lung 2, LUX-Lung 3, and LUX-Lung 6. Lancet Oncol 16: 830-838.
17. Yang JC, Wu YL, Schuler M et al (2015) Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): Analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 16:141-51.
18. Jung HA, Woo SY, Lee SH et al (2020) The different central nervous system efficacy among gefitinib, erlotinib and afatinib in patients with epidermal growth factor receptor mutation-positive non-small cell lung cancer. Transl Lung Cancer Res 9: 1749-1758.
19. Liang SK, Lee MR, Liao WY et al (2018) Prognostic factors of afatinib as a first-line therapy for advanced EGFR mutation-positive lung adenocarcinoma: A real-world, large cohort study. Oncotarget 9(34): 23749-23760.