First- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors in a large, real-world cohort of patients with non-small cell lung cancer

被引：16

作者：

Huang, Allen Chung-Cheng ^{[2
,4
]}

Huang, Chi-Hsien ^{[4
]}

Ju, Jia-Shiuan ^{[2
,4
]}

Chiu, Tzu-Hsuan ^{[4
]}

Tung, Pi-Hung ^{[4
]}

Wang, Chin-Chou ^{[5
]}

Liu, Chien-Ying ^{[2
,4
]}

Chung, Fu-Tsai ^{[2
,4
]}

Fang, Yueh-Fu ^{[4
]}

Guo, Yi-Ke ^{[3
]}

Kuo, Chih-Hsi Scott ^{[1
,2
,3
]}

Yang, Cheng-Ta ^{[2
,6
]}

机构：

[1] Chang Gung Univ, Div Thorac Oncol, Dept Thorac Med, Chang Gung Mem Hosp,Coll Med, 199 Tun Hwa Nr Rd, Taipei 333, Taiwan

[2] Chang Gung Mem Hosp, Canc Ctr, Thorac Oncol Unit, Taoyuan, Taiwan

[3] Imperial Coll London, Data Sci Inst, Dept Comp, London, England

[4] Chang Gung Univ, Div Thorac Oncol, Dept Thorac Med, Chang Gung Mem Hosp,Coll Med, Gueishan, England

[5] Kaohsiung Chang Gung Mem Hosp, Div Pulm & Crit Care Med, Kaohsiung, Niaosung, Taiwan

[6] Chang Gung Univ, Div Thorac Oncol, Dept Thorac Med, Chang Gung Mem Hosp,Coll Med, Taiyuan, Peoples R China

来源：

THERAPEUTIC ADVANCES IN MEDICAL ONCOLOGY | 2021年 / 13卷

关键词：

afatinib; EGFR mutation; erlotinib; gefitinib; NSCLC; real world; EGFR-MUTATION; 1ST-LINE TREATMENT; OPEN-LABEL; PHASE-III; ADENOCARCINOMA PATIENTS; CARBOPLATIN-PACLITAXEL; CIGARETTE-SMOKING; ASIAN PATIENTS; SURVIVAL-DATA; AFATINIB;

D O I：

10.1177/17588359211035710

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: There are limited comparisons of first- and second-generation EGFR tyrosine kinase inhibitors (TKIs) in large, real-world cohorts of non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. Methods: Patients with advanced NSCLC (N=612) with common EGFR mutations receiving first-line gefitinib/erlotinib and afatinib were grouped and propensity-score matched. Progression-free survival (PFS), overall survival (OS) and secondary T790M mutations were analyzed. Results: The gefitinib/erlotinib and afatinib groups each contained 206 patients after matching. Compared with gefitinib/erlotinib, patients receiving afatinib achieved longer median PFS (16.3 versus 14.2months; log-rank test p=0.020) and had a lower risk of progression [hazard ratio (HR) 0.73 (95% confidence interval (CI), 0.57-0.94); p=0.017]. Median OS (37.3 versus 34.2months; log-rank test p=0.500) and reduction in risk of death [HR 0.89 (95% CI, 0.65-1.23); p=0.476] did not differ significantly between groups. T790M positivity was significantly higher in the gefitinib/erlotinib than afatinib group (70.9% versus 44.6%, p<0.001). Multivariate analysis demonstrated that afatinib was independently associated with lower T790M positivity [odds ratio (OR) 0.27 (95% CI, 0.14-0.53); p<0.001], whereas 12months PFS after EGFR-TKI treatment [OR 3.00 (95% CI, 1.56-5.98); p=0.001] and brain metastasis [OR 2.12 (95% CI, 1.08-4.26); p=0.030] were associated with higher T790M positivity. Sequential third-generation EGFR-TKI treatment was administered to 63 patients, in whom median OS after the second-third-generation and first-third-generation EGFR-TKI sequences were 38.8 and 29.1months, respectively. Conclusion: Compared with gefitinib/erlotinib, afatinib had a higher treatment efficacy and a lower secondary T790M positivity in a large, real-world cohort of Asian patients with EGFR-mutated NSCLC.

引用

页数：13

共 41 条

[41] Concurrent Alterations in EGFR-Mutant Lung Cancers Associated with Resistance to EGFR Kinase Inhibitors and Characterization of MTOR as a Mediator of Resistance [J].

Yu, Helena A. ;

Suzawa, Ken ;

Jordan, Emmet ;

Zehir, Ahmet ;

Ni, Ai ;

Kim, Ryan ;

Kris, Mark G. ;

Hellmann, Matthew D. ;

Li, Bob T. ;

Somwar, Romel ;

Solit, David B. ;

Berger, Michael F. ;

Arcila, Maria ;

Riely, Gregory J. ;

Ladanyi, Marc .

CLINICAL CANCER RESEARCH, 2018, 24 (13) :3108-3118

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