Dacomitinib as a First-Line Therapy for Advanced EGFR-Mutated Non-Small Cell Lung Cancer Without Brain Metastases: A
Ping-Chih Hsu1,2, How-Wen Ko1,2, Li-Chung Chiu1,2
1Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.
Background:
Real-world evidence regarding the use of dacomitinib as a first-line therapy for advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations remains limited. This multicenter, retrospective cohort study aimed to evaluate the clinical outcomes of dacomitinib as a first-line treatment in patients with untreated advanced EGFR-mutant NSCLC without brain metastases.
Patients And Methods:
This retrospective analysis included 161 patients with stage IIIB/IV EGFR-mutant NSCLC without brain metastasis at baseline who received first-line dacomitinib between October 2020 and August 2023 at four Taiwanese cancer centers. The primary outcomes included the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), predictive risk factors for PFS, and adverse events (AEs).
Results:
The ORR was 64.0%, and the disease control rate (DCR) reached 91.3%. The median PFS was 20.93 months (95% CI: 17.55-24.32), and the median OS was 41.27 months (95% CI: 31.71-50.82). Multivariate analysis revealed that an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, bone metastasis, and liver metastasis were independent predictors of shorter PFS. Among patients who experienced disease progression and underwent rebiopsy, the secondary T790M mutation rate was 50.6%. Most treatment-related AEs were grade 1-2 and manageable.
Conclusions:
Dacomitinib demonstrated favorable efficacy and tolerability as a first-line therapy in advanced NSCLC patients with common EGFR mutations (exon 19 deletion or L858R). A baseline ECOG PS ≥ 2 and the presence of bone or liver metastases were significantly associated with worse PFS, suggesting a need for additional therapeutic strategies in these subgroups.
Insights
Dacomitinib shows good results as a first-line treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations. Patients with poor performance status or bone/liver metastases may need different strategies.
Area of Science:
- Oncology
- Pharmacology
Background:
- Limited real-world data on first-line dacomitinib for advanced EGFR-mutant NSCLC.
- Dacomitinib is an EGFR tyrosine kinase inhibitor.
Purpose of the Study:
- Evaluate clinical outcomes of first-line dacomitinib in advanced EGFR-mutant NSCLC without brain metastases.
- Assess objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs).
Main Methods:
- Retrospective cohort study of 161 patients with stage IIIB/IV EGFR-mutant NSCLC.
- Patients received first-line dacomitinib between October 2020 and August 2023.
- Outcomes included ORR, PFS, OS, predictive factors for PFS, and AEs.
Main Results:
- ORR was 64.0%, and disease control rate (DCR) was 91.3%.
- Median PFS was 20.93 months; median OS was 41.27 months.
- ECOG PS ≥2, bone, and liver metastases predicted shorter PFS. Secondary T790M mutation rate was 50.6% upon progression.
Conclusions:
- Dacomitinib is effective and well-tolerated for first-line treatment of advanced NSCLC with common EGFR mutations.
- Poor ECOG PS and bone/liver metastases are associated with worse PFS, indicating a need for alternative therapies in these subgroups.
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