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Dacomitinib in the Management of Advanced Non-Small-Cell Lung Cancer

Sally C M Lau1, Ullas Batra2, Tony S K Mok3,4

  • 1Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Drugs
|May 10, 2019
PubMed

Insights

Second-generation dacomitinib shows improved survival over gefitinib for first-line treatment of advanced EGFR-mutated non-small-cell lung cancer. Dacomitinib is recommended only for patients with known EGFR mutations.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Targeted therapy, specifically epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), represents a significant advancement in treating advanced non-small-cell lung cancer (NSCLC).
  • Dacomitinib, a second-generation irreversible EGFR TKI, has demonstrated efficacy in early-phase studies for NSCLC management.

Purpose of the Study:

  • To evaluate the efficacy and safety of dacomitinib compared to gefitinib as a first-line treatment for patients with EGFR-mutated advanced NSCLC.

Main Methods:

  • The ARCHER 1050 phase III study compared oral dacomitinib (45 mg/day) with gefitinib in a first-line setting for advanced NSCLC patients with EGFR-sensitizing mutations.

Main Results:

  • Dacomitinib demonstrated superiority over gefitinib in improving both progression-free survival and overall survival.
  • Dacomitinib is associated with increased toxicities, including diarrhea, rash, stomatitis, and paronychia, compared to first-generation EGFR inhibitors.
  • Global quality of life was maintained in phase III studies.

Conclusions:

  • Dacomitinib is a valuable first-line treatment option for patients with EGFR-mutated NSCLC who are otherwise fit and can tolerate its associated toxicities.
  • The use of dacomitinib should be restricted to patients with confirmed EGFR-sensitizing mutations and is not recommended as subsequent therapy or in unselected NSCLC populations.

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