Clinical Outcomes of Afatinib Versus Osimertinib in Patients With Non-Small Cell Lung Cancer With Uncommon EGFR
Chunsheng Wang1, Kewei Zhao2, Shanliang Hu3
1Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
Background:
The purpose of this analysis was to investigate the effectiveness of afatinib compared to that of osimertinib in patients with non-small cell lung cancer (NSCLC) who harbored uncommon epidermal growth factor receptor (EGFR) mutations.
Methods:
A PubMed database-based literature review was conducted to retrieve related studies. Patients harboring EGFR mutations besides the deletion in exon 19 (19del) and point mutation of L858R were included in this analysis. The primary outcome events were the objective response rate (ORR) and progression-free survival (PFS). Propensity score matching (PSM) at a ratio of 1:1 was used between afatinib and osimertinib groups to control the confounding factors. Uncommon EGFR mutations were categorized into 4 groups: insertion in exon 20 (ex20ins), non-ex20ins single uncommon EGFR mutations, compound EGFR mutations that with 19del or L858R, and compound EGFR mutations without 19del or L858R.
Results:
After PSM, 71 patients in either the afatinib or osimertinib group were matched. The afatinib group had an ORR of 60.6%, slightly higher than the osimertinib group's (50.3%), the difference was not statistically significant (P = .610). However, the afatinib group showed a significantly superior PFS benefit than the osimertinib group (11.0 vs. 7.0 months, P = .044). In addition, patients harboring non-ex20ins single uncommon EGFR mutations yield the best ORR and PFS, following treatment of either afatinib (ORR: 76.7%, mPFS: 14.1 months) or osimertinib (ORR: 68.8%, mPFS: 15.1 months). Moreover, there was no significant difference in terms of ORR or PFS between the cohort of patients treated with afatinib or osimertinib, regardless of whether or not the patients had brain metastases.
Conclusions:
Both afatinib and osimertinib displayed favorable clinical activities toward uncommon EGFR mutations. Afatinib showed a more profound and durable PFS benefit than osimertinib, although no efficacy advantage was observed.
Insights
Afatinib demonstrated a significantly longer progression-free survival (PFS) compared to osimertinib in non-small cell lung cancer (NSCLC) patients with uncommon EGFR mutations. While both drugs showed activity, afatinib offered a more durable benefit.
Area of Science:
- Oncology
- Pharmacology
- Genetics
Background:
- Non-small cell lung cancer (NSCLC) treatment often targets specific mutations.
- Uncommon epidermal growth factor receptor (EGFR) mutations present unique therapeutic challenges.
- Targeted therapies like afatinib and osimertinib are crucial in managing NSCLC with specific genetic profiles.
Conclusions:
- Both afatinib and osimertinib exhibit clinical activity against uncommon EGFR mutations in NSCLC.
- Afatinib provides a more substantial and longer-lasting PFS benefit compared to osimertinib.
- Neither drug showed a definitive overall efficacy advantage, but afatinib's PFS benefit warrants consideration.
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