ISSN: 1859 - 2872
Compare the effectiveness of afatinib and gefitinib as first-line treatment in patients with advanced stage non-small cell lung cancer haboring common EGFR mutations: Real-world data on PFS
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Abstract
Objective: To compare the effectiveness of afatinib and gefitinib as first-line treatment in patients with advanced stage non-small cell lung cancer (NSCLC) with common EGFR mutations. Subject and method: This is a retrospective study, patients with advanced stage NSCLC harboring EGFR mutation deletion of exon 19 and L858R point mutation on exon 21 treated as a first line with afatinib or gefitinib from January 2019 to December 2023. Patients were flow-up and assessed for response every 3 months or when they had symptoms of progression. The primary endpoints were progression-free survival (PFS), objective response rate (ORR), secondary endpoints were disease control rate (DCR), and adverse events. Stratified by EGFR mutations, and brain metastasis. Result: There were 137 patients participating, afatinib 65 patients and gefitinib 72 patients. The average age of patients in the afatinib and gefitinib groups was 60.2 years and 65.5 years old, respectively (p=0.04). The number of patients with brain metastasis treated by afatinib was 24 patients and gefitinib was 16 patients. ORR was 90.7% in the afatinib group and 81.9% in the gefitinib group with p=0.46. DCR was equal between the 2 groups. Median PFS in the afatinib group was 15.8 months and the gefitinib group was 14.4 months, p=0.55. The median PFS of patients with brain metastasis was equivalent to 13 months in the afatinib group and 12 months in the gefitinib group (p=0.51). Patients with the L858R mutation treated by afatinib had a median PFS of 17.6 months longer than the gefitinib group with 14 months, on the contrary, patients with the exon 19 deletion mutation treated by gefitinib and afatinib achieved a median PFS of 17.1 months versus 14.5 months, respectively (p=0.68). Side effects occurred in 73.8% of patients treated with afatinib higher than the group treated with gefitinib at 44.4%. There was 1 patient with rash and 1 patient with diarrhea at grade 3 due to afatinib, and 3 patients had grade 3 of increasing liver enzyme due to gefitinib. Conclusion: Afatinib and gefitinib have good effects in advanced stage NSCLC patients with common EGFR mutations. However, the percentage of adverse events in the afatinib arm was higher than in gefitinib arm.
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References
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