1
|
Treatment Patterns, Clinical Outcomes and Health Care Resource Utilisation in Patients with EGFR-mutated Metastatic Non-Small Cell Lung Cancer: A Real-World Study in South Korea. Drugs Real World Outcomes 2022; 10:131-143. [PMID: 36456850 PMCID: PMC9715413 DOI: 10.1007/s40801-022-00344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite the dynamic treatment landscape for EGFR mutant-positive metastatic non-small cell lung cancer (EGFRm+ mNSCLC), most of the earlier studies have focused on US or Western populations. OBJECTIVE The objective of this study was to explore real-world treatment patterns and outcomes of South Korean patients with EGFRm+ mNSCLC. METHODS Retrospective chart review of adult patients with EGFRm+ mNSCLC who received systemic treatment between January-2019 and June-2019. RESULTS A total of 162 patients were included from 21 hospitals, with a median follow-up of 15.6 months. Median age was 65.0 years, 22% had central nervous system metastasis, and 57% and 38% had exon 19 deletion and exon 21 L858R, respectively. Among 144 patients (89%) who received first-line EGFR-tyrosine kinase inhibitor, afatinib was most the common (44%), followed by gefitinib (28%) and erlotinib (13%). First-line chemotherapy was more common when an EGFR-mutation was detected after versus before first-line treatment initiation (31% vs 5%). Discontinuation of first-line treatment was mostly due to disease-progression (81%) and toxicity (7%). Among 58 (78%) patients who received second-line treatment, osimertinib was the most common (40%). Most (60%) patients reported ≥1 Grade ≥3 adverse event during first-line treatment. Following initiation of first-line treatment, physician visits and chest X-rays were the most frequent healthcare utilisation events. Rates of emergency-room visits and hospitalization were 12% and 16%, respectively, with a mean length-of-stay of 10.4 days. At 12 months, overall survival rate was 95%, and numerically worse for patients with exon 21 versus 19 mutations. CONCLUSIONS Characteristics and clinical outcomes of Korean patients with EGFRm+ mNSCLC in real-world practice were comparable to those observed in clinical trials. As osimertinib was not reimbursed for first-line treatment before study completion, further investigation is warranted to explore evolving treatment practice.
Collapse
|
2
|
Chang GC, Lam DCL, Tsai CM, Chen YM, Shih JY, Aggarwal S, Wang S, Kim SW, Kim YC, Wahid I, Li R, Lim DWT, Sriuranpong V, Chan RTT, Lorence RM, Carriere P, Raabe C, Cseh A, Park K. Experience from Asian centers in a named-patient-use program for afatinib in patients with advanced non-small-cell lung cancer who had progressed following prior therapies, including patients with uncommon EGFR mutations. Int J Clin Oncol 2021; 26:841-850. [PMID: 33783657 PMCID: PMC8055616 DOI: 10.1007/s10147-021-01869-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study evaluated outcomes among patients with advanced/metastatic non-small-cell lung cancer (NSCLC) treated at Asian centers participating in the global named-patient-use (NPU) program for afatinib. METHODS Patients had progressed after initial benefit with erlotinib or gefitinib, and/or had an EGFR or HER2 mutation, had no other treatment options, and were ineligible for afatinib trials. The recommended starting dose of afatinib was 50 mg/day. Dose modifications were allowed, and afatinib was continued as long as deemed beneficial. Response and survival information was provided voluntarily. Safety reporting was mandatory. RESULTS 2242 patients (26% aged ≥ 70 years, 96% with adenocarcinoma) received afatinib at centers in 10 Asian countries. Most were heavily pre-treated, including prior treatment with erlotinib or gefitinib. Of 1281 patients tested, 1240 had EGFR mutations (common: 1034/1101; uncommon: 117/1101). There were no new safety signals, the most common adverse events being rash and diarrhea. Objective response rate (ORR) was 24% overall (n = 431 with data available), 27% for patients with common EGFR mutations (n = 230) and 28% for those with uncommon mutations (n = 32); median time to treatment failure (TTF) in these groups was 7.6 months (n = 1550), 6.4 months (n = 692) and 8.4 months (n = 83), respectively. In patients with EGFR exon 20 insertions (n = 23) and HER2 mutations (n = 12), median TTF exceeded 12 months. CONCLUSIONS Patient outcomes in this study were similar to those reported in the analysis of the global NPU. Afatinib achieved clinical benefits in patients with refractory NSCLC. ORR and TTF were similar between patients with tumors harboring uncommon and common EGFR mutations.
Collapse
Affiliation(s)
- Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | | | | | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming Medical University, Taipei, Taiwan
| | | | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Chul Kim
- Chonnam National University, Hwasun Hospital, Jeonnam, Republic of Korea
| | - Ibrahim Wahid
- Beacon International Specialist Centre, Selangor, Malaysia
| | - Rubi Li
- St Luke's Medical Center, Quezon City, Philippines
| | | | - Virote Sriuranpong
- Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Pathumwan, Bangkok, Thailand
| | | | | | | | - Christina Raabe
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Choi H, Lee JK, Oh HJ, Kim MS, Kho BG, Park CK, Oh IJ, Kim YC. Efficacy and dose of afatinib in patients with non-small cell lung cancer after failure of prior gefitinib or erlotinib treatment. Thorac Cancer 2021; 12:1598-1604. [PMID: 33811467 PMCID: PMC8107028 DOI: 10.1111/1759-7714.13957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 01/04/2023] Open
Abstract
Background We report a subgroup analysis of afatinib with respect to its efficacy, safety, and the long‐term survival of patients in a Named Patient Use program at a single institution. Methods We analyzed 60 patients with stage IV non‐small cell lung cancer (NSCLC) who had been treated with ≥1 line of platinum‐based chemotherapy and had activating epidermal growth factor receptor (EGFR) mutations or disease control for ≥6 months with prior EGFR inhibitors. Afatinib was started on a daily dose of 50 mg, which was decreased according to the adverse events and tolerability. Results A total of 13 patients achieved partial remission, whereas 33, 12, and two showed stable disease, had progression, and were not evaluable, respectively, resulting in an objective response rate and disease control rate of 21.7% and 76.7%, respectively. The median progression‐free survival (PFS) was 5.4 (95% confidence interval [CI]: 4.0–7.7) months and median overall survival (OS) was 10.1 (8.5–13.6) months. Toxicities leading to drug discontinuation were experienced by four patients (6.7%). Grade 3 diarrhea occurred in 10 patients (16.7%), and afatinib dose reductions were required in 35 patients. The PFS and OS were significantly longer for patients whose dose was reduced to 40 or 30 mg than for those without dose reduction (7.0 vs 3.1 months and 13.5 vs 8.1 months, respectively, p < 0.05). Conclusions The efficacy of afatinib was similar to that identified in the global data without unexpected adverse events. Survival analyses support the currently approved dose of afatinib as first‐line treatment for NSCLC.
Collapse
Affiliation(s)
- Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jae-Kyeong Lee
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Hyung-Joo Oh
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Min-Seok Kim
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Bo Gun Kho
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Cheol Kyu Park
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - In-Jae Oh
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Young-Chul Kim
- Lung and Esophageal Cancer Clinic, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| |
Collapse
|
4
|
Jiang Y, Chen W, Yu W, Shi N, Han G, Mao S, Zhang X, Chen M. Survival analysis of afatinib versus erlotinib for individuals with advanced del19 lung adenocarcinoma with asymptomatic brain metastasis after pemetrexed-cisplatin chemotherapy: a retrospective study. J Int Med Res 2020; 48:300060520937093. [PMID: 32804557 PMCID: PMC7432978 DOI: 10.1177/0300060520937093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate survival following afatinib (AF) and erlotinib (ER) treatment in
advanced del19 lung adenocarcinoma (AD19LA) with asymptomatic brain
metastasis (ABM) after pemetrexed–cisplatin chemotherapy (PCC). Methods Data were retrospectively analysed from individuals with AD19LA and ABM after
PCC who received AF or ER for 2 years or until intolerable adverse events
(AEs), withdrawal, or death. The primary outcome was survival; secondary
outcomes were AEs. Results The final analysis included 174 AD19LA individuals (AF: n = 86; ER: n = 88)
with a median follow-up of 24.2 months (IQR 2.1–28.3). Significant
differences in overall survival (16.2 months [95%CI 15.4–17.1] for AF vs 7.2
months [95%CI 6.3–8.1] for ER) (HR 0.50, 95%CI 0.36–0.71, p<0.0001) and
median progression-free survival (9.4 months [95%CI 8.5–9.7] for AF vs 5.6
months [4.7–6.2] for ER) (HR 0.66, 95%CI 0.47–0.94, p=0.02) were observed
between the groups. Rates of all-grade AEs were 82.5% for AF and 72.7% for
ER, and rates of grade ≥3 AEs were 37.2% for AF and 34.0% for ER. Conclusion Compared with ER, AF treatment may be more beneficial in terms of survival in
the management of AD19LA after PCC with a tolerable safety profile.
Collapse
Affiliation(s)
- Ye Jiang
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Wenli Chen
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ning Shi
- Department of Nuclear medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Guowei Han
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuai Mao
- Department of Cardiology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xinlei Zhang
- Department of Cardiology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
5
|
Sutandyo N, Hanafi A, Jayusman M. [Comparison of Effectiveness of Gefitinib, Erlotinib, and Afatinib in Advanced Non-small Cell Lung Cancer Patients with EGFR Mutation Positive in Indonesian Population]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:562-567. [PMID: 31526459 PMCID: PMC6754576 DOI: 10.3779/j.issn.1009-3419.2019.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and objective EGFR-tyrosine kinase inhibitors (EGFR-TKIs) were used to treat non-small cell lung cancer (NSCLC) patients with EGFR mutation positive. This study aims to compare the effectiveness of first line TKIs; gefitinib, erlotinib, and afatinib in the treatment of advanced stage NSCLC patients with EGFR mutation positive in the Indonesian population. Methods A retrospective cohort study of 88 NSCLC patients with EGFR mutation positive treated with gefitinib (n=59), erlotinib (n=22), and afatinib (n=7) was performed in national cancer hospital in Indonesia.Inclusion criteria were stage Ⅲb or Ⅳ NSCLC with adenocarcinoma subtype. Subjects less than 18 years or with a history of other malignancy were excluded. Outcomes were treatment response, progression-free survival (PFS), and mortality rate. Results Complete response, partial response, and stable disease were shown in 1.1%, 35.2%, and 31.8% of subjects, respectively. There were 31.8% of subjects developed progressive disease during treatment. Regarding EGFR mutation positive profile, a total of 56.8% subjects had deletion in exon 19, 42% subjects had mutation in exon 21, and rare mutation in exon 18 was found in 3.4% of total subjects. Demography and clinical characteristics had no significant association with the risk of progressive disease. The median PFS of subjects was 11 months (95%CI: 6.8-15.2 months). There was no statistical difference of PFS between treatment groups. Conclusion Gefitinib, erlotinib, and afatinib have similar effectiveness in advanced stage NSCLC with EGFR mutation positive. Afatinib tends to be associated with longer PFS but further investigation is required.
Collapse
Affiliation(s)
- Noorwati Sutandyo
- Division of Hematology and Medical Oncology, Department of Internal Medicine
| | - Arif Hanafi
- Department of Pulmonology, Dharmais National Cancer Centre Hospital, Jakarta, Indonesia
| | - Mulawarman Jayusman
- Department of Pulmonology, Dharmais National Cancer Centre Hospital, Jakarta, Indonesia
| |
Collapse
|