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Advanced non-small cell lung cancer (NSCLC) with activating EGFR mutations: first-line treatment with afatinib and

Wolfgang Brückl1, Amanda Tufman2, Rudolf Maria Huber2

  • 1a Department of Respiratory Medicine, Allergology and Sleep Medicine , Paracelsus Medical University, General Hospital Nuernberg , Nuremberg , Germany.

Expert Review of Anticancer Therapy
|November 30, 2016
PubMed
Abstract

Insights

Second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), like afatinib, show improved overall survival compared to chemotherapy for advanced non-small cell lung cancer (NSCLC) with EGFR mutations.

Area of Science:

  • Oncology
  • Molecular Biology
  • Pharmacology

Background:

  • Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are now standard first-line therapy for advanced non-small cell lung cancer (NSCLC) with activating EGFR mutations.
  • First-generation EGFR TKIs (erlotinib, gefitinib) improved progression-free survival but not overall survival compared to platinum-based chemotherapy.
  • This review focuses on the EGFR pathway, its role in NSCLC, and the efficacy of first- and next-generation EGFR TKIs.

Purpose of the Study:

  • To review the differential molecular and clinical activity of first- and next-generation EGFR TKIs in first-line treatment of NSCLC with activating EGFR mutations.
  • To provide an updated overview of EGFR TKIs, with a specific focus on the second-generation agent afatinib.

Main Methods:

  • Comprehensive literature search of clinical trials and recent meeting abstracts.
  • Review of data on first-generation EGFR TKIs (erlotinib, gefitinib) and second-generation afatinib.
  • Analysis of head-to-head comparisons and subgroup analyses, particularly for the Del19 mutation.

Main Results:

  • Afatinib demonstrated a significant overall survival advantage over platinum doublet chemotherapy in LUX-Lung 3 and 6 trials, especially for Del19 mutated NSCLC.
  • Afatinib showed improved efficacy compared to gefitinib across various endpoints in patients with common EGFR mutations.
  • First-generation EGFR TKIs showed good tolerability and improved progression-free survival but not overall survival.

Conclusions:

  • Afatinib represents a promising first-line treatment option for patients with advanced NSCLC harboring activating EGFR mutations.
  • Second-generation EGFR TKIs offer improved overall survival benefits compared to first-generation agents and chemotherapy.
  • Targeted therapy with EGFR TKIs is crucial for managing NSCLC with specific driver mutations.
Keywords:
AfatinibEGFRNSCLCerlotinibgefitinibmutation-positive

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