Real-world first-line afatinib for advanced EGFR mutation-positive non-small cell lung cancer in Korea: updated
Juwhan Choi1, Chang Min Choi2, Yoon Soo Chang3
1Division of Pulmonary, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea.
Background:
Data from clinical trials and real-world studies show that afatinib is effective in treating non-small cell lung cancer (NSCLC) harboring activating mutations in the epidermal growth factor receptor (EGFR) gene. A previous analysis of patients enrolled in the Korean Academy of Tuberculosis and Respiratory Disease (KATRD) EGFR cohort showed that first-line afatinib was well tolerated and effectiveness results were encouraging. At the time of the previous analysis, survival data were not mature. Here we briefly present updated survival data from the cohort.
Methods:
The study was a retrospective, multicenter (15 sites) review of electronic records of Korean adult patients (aged >20 years) with advanced EGFR mutation-positive NSCLC who initiated first-line afatinib (N=421). Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier survival curves.
Results:
Overall, median PFS was 20.2 months and median OS was 48.6 months. OS rates at 36 and 60 months were 60.1% and 42.3%, respectively. Presence vs. absence of baseline brain metastases was associated with significantly reduced median PFS (14.9 vs. 28.0 months; P<0.001) and median OS (32.2 vs. 65.6 months; P<0.001). The presence of common baseline EGFR mutations (Del19, L858R) was associated with significantly prolonged median OS (49.6 vs. 30.1 months; P=0.017). In patients stratified by the presence/absence of T790M EGFR mutation, the T790M mutation was associated with significantly reduced median PFS (P=0.0005) but there was no significant difference between groups in survival (P=0.263). There were no significant differences in PFS or OS for patients stratified by afatinib dose reduction or by age group (<70 vs. ≥70 years).
Conclusions:
Afatinib was effective in Korean patients with EGFR mutation-positive NSCLC with median OS over 4 years. The presence of baseline brain metastases and/or uncommon EGFR mutations were associated with reduced survival. In the absence of baseline brain metastases, median OS was more than 5 years.
Insights
Updated survival data show afatinib is effective for EGFR-mutated non-small cell lung cancer (NSCLC) in Korean patients, with median overall survival exceeding 4 years. Baseline brain metastases and uncommon EGFR mutations were linked to poorer outcomes.
Area of Science:
- Oncology
- Pharmacology
- Genetics
Background:
- Afatinib demonstrates efficacy in non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutations.
- Previous analyses of the Korean Academy of Tuberculosis and Respiratory Disease (KATRD) EGFR cohort indicated afatinib's tolerability and encouraging effectiveness in first-line treatment.
- Updated survival data are presented from the KATRD EGFR cohort where survival data were previously immature.
Purpose of the Study:
- To present updated survival data for Korean patients with advanced EGFR mutation-positive NSCLC treated with first-line afatinib.
- To evaluate the impact of baseline characteristics, including brain metastases and specific EGFR mutations, on progression-free survival (PFS) and overall survival (OS).
Main Methods:
- Retrospective, multicenter review of electronic records for 421 Korean adult patients with advanced EGFR mutation-positive NSCLC initiating first-line afatinib.
- Evaluation of progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival curves.
- Analysis of survival outcomes stratified by the presence of baseline brain metastases, common (Del19, L858R) and T790M EGFR mutations, age, and afatinib dose reduction.
Main Results:
- Median PFS was 20.2 months and median OS was 48.6 months.
- Presence of baseline brain metastases significantly reduced median PFS (14.9 vs. 28.0 months) and OS (32.2 vs. 65.6 months).
- Common EGFR mutations (Del19, L858R) were associated with significantly prolonged median OS (49.6 vs. 30.1 months), while T790M mutation was linked to reduced PFS but not OS.
Conclusions:
- Afatinib is effective in Korean patients with EGFR mutation-positive NSCLC, achieving a median OS exceeding 4 years.
- Baseline brain metastases and uncommon EGFR mutations are associated with reduced survival outcomes.
- In patients without baseline brain metastases, the median OS surpassed 5 years, highlighting the importance of this prognostic factor.
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