Afatinib as First-Line Treatment in Elderly Patients with EGFR-Mutant Non-Small Cell Lung Cancer: Real-World Data Analysis

Background: Afatinib, a second-generation tyrosine kinase inhibitor (TKI), showed better overall survival (OS) in treatment-naive advanced non-small cell lung cancer (NSCLC) patients with exon 19 deletion. However, treatment-related adverse events of afatinib are more common than those of first-generation TKIs. This study aimed to evaluate real-world data regarding the efficacy and treatment-related adverse events of afatinib in elderly patients with NSCLC. Methods: In this retrospective study, we analyzed the real-world data of patients with NSCLC harboring epidermal growth factor receptor (EGFR) mutation who were treated with afatinib between January 2014 and December 2020 in Mackay Memorial Hospital. We analyzed and compared time to treatment failure (TTF), OS, treatment-related adverse events, and time to dose reduction between the young (age < 65 years) and elderly (age >= 65 years) groups. Results: Treatment-related adverse events were comparable in the young and elderly groups. The median time to dose reduction was 1.04 months in the young group and 2.41 months in the elderly group (p = 0.78). The TTF (15.2 months vs. 12.2 months, p = 0.33) and OS (26.5 months vs. 23.8 months, p = 0.65) of afatinib were similar in the young and elderly groups. Conclusions: Based on the results of this study, the efficacy and treatment-related adverse events of afatinib were similar in the young and elderly groups. Therefore, afatinib can be safely used in elderly patients with advanced NSCLC harboring EGFR mutation without an increase in side effects. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.