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Khasraw M, Yalamanchili P, Santhanagopal A, Wu C, Salas M, Meng J, Karnoub M, Esker S, Felip E. Clinical Management of Patients with Non-Small Cell Lung Cancer, Brain Metastases, and Actionable Genomic Alterations: A Systematic Literature Review. Adv Ther 2024; 41:1815-1842. [PMID: 38509433 PMCID: PMC11052832 DOI: 10.1007/s12325-024-02799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/19/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Nearly 60% of patients with non-small cell lung cancer (NSCLC) present with metastatic disease, and approximately 20% have brain metastases (BrMs) at diagnosis. During the disease course, 25-50% of patients will develop BrMs. Despite available treatments, survival rates for patients with NSCLC and BrMs remain low, and their overall prognosis is poor. Even with newer agents for NSCLC, options for treating BrMs can be limited by their ineffective transport across the blood-brain barrier (BBB) and the unique brain tumor microenvironment. The presence of actionable genomic alterations (AGAs) is a key determinant of optimal treatment selection, which aims to maximize responses and minimize toxicities. The objective of this systematic literature review (SLR) was to understand the current landscape of the clinical management of patients with NSCLC and BrMs, particularly those with AGAs. METHOD A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant SLR was conducted to identify studies in patients with BrMs in NSCLC. Searches used the EMBASE and MEDLINE® databases, and articles published between January 1, 2017 and September 26, 2022 were reviewed. RESULTS Overall, 179 studies were included in the SLR. This subset review focused on 80 studies that included patients with NSCLC, BrMs, and AGAs (19 randomized controlled trials [RCTs], two single-arm studies, and 59 observational studies). Sixty-four of the 80 studies reported on epidermal growth factor receptor (EGFR) mutations, 14 on anaplastic lymphoma kinase (ALK) alterations, and two on both alterations. Ninety-five percent of studies evaluated targeted therapy. All RCTs allowed patients with previously treated, asymptomatic, or neurologically stable BrMs; the percentage of asymptomatic BrMs varied across observational studies. CONCLUSIONS Although targeted therapies demonstrate systemic benefits for patients with NSCLC, BrMs, and AGAs, there remains a continued need for effective therapies to treat and prevent BrMs in this population. Increased BBB permeability of emerging therapies may improve outcomes for this population.
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Affiliation(s)
- Mustafa Khasraw
- The Duke Cancer Institute, School of Medicine, Duke University, 20 Duke Medicine Cir, Durham, NC, 27710, USA.
| | | | | | - Chuntao Wu
- Daiichi Sankyo, Inc, Basking Ridge, NJ, USA
| | - Maribel Salas
- Daiichi Sankyo, Inc, Basking Ridge, NJ, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Jie Meng
- Daiichi Sankyo Europe GmbH, Munich, Germany
| | | | | | - Enriqueta Felip
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Cheng WC, Lin CC, Liao WC, Lin YC, Chen CH, Chen HJ, Tu CY, Hsia TC. The difference between dacomitinib and afatinib in effectiveness and safety in first-line treatment of patients with advanced EGFR-mutant non-small cell lung cancer: a real-world observational study. BMC Cancer 2024; 24:228. [PMID: 38373960 PMCID: PMC10875818 DOI: 10.1186/s12885-024-11956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES The irreversible epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) afatinib and dacomitinib are approved for first-line treatment of EGFR mutation-positive non-small cell lung cancer (NSCLC). We aimed to compare the efficacy and safety of afatinib and dacomitinib in this setting. MATERIALS AND METHODS Between September 2020 and March 2023, we retrospectively recruited patients diagnosed with advanced-stage EGFR-mutant NSCLC who were treated with first-line irreversible EGFR-TKIs. The enrolled patients were assigned to two groups based on whether they received afatinib or dacomitinib. RESULTS A total of 101 patients were enrolled in the study (70 to afatinib and 31 to dacomitinib). The partial response rates (PR) for first-line treatment with afatinib and dacomitinib were 85.7 and 80.6% (p = 0.522). The median progression-free survival (PFS) (18.9 vs. 16.3 months, p = 0.975) and time to treatment failure (TTF) (22.7 vs. 15.9 months, p = 0.324) in patients with afatinib and dacomitinib treatment were similar. There was no significant difference observed in the median PFS (16.1 vs. 18.9 months, p = 0.361) and TTF (32.5 vs. 19.6 months, p = 0.182) between patients receiving the standard dose and those receiving the reduced dose. In terms of side effects, the incidence of diarrhea was higher in the afatinib group (75.8% vs. 35.5%, p < 0.001), while the incidence of paronychia was higher in the dacomitinib group (58.1% vs. 31.4%, p = 0.004). The PFS (17.6 vs. 24.9 months, p = 0.663) and TTF (21.3 vs. 25.1 months, p = 0.152) were similar between patients younger than 75 years and those older than 75 years. CONCLUSION This study showed that afatinib and dacomitinib had similar effectiveness and safety profiles. However, they have slightly different side effects. Afatinib and dacomitinib can be safely administered to patients across different age groups with appropriate dose reductions.
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Affiliation(s)
- Wen-Chien Cheng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
- PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chi-Chien Lin
- Institute of Biomedical Science, the iEGG and Animal Biotechnology Center, Advanced Plant and Food Crop Biotechnology Center, National Chung-Hsing University, Taichung, Taiwan.
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Chao Lin
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Jen Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Tung PH, Chiu TH, Huang ACC, Ju JS, Huang CH, Wang CC, Ko HW, Chung FT, Hsu PC, Fang YF, Guo YK, Kuo CHS, Yang CT. Differential prognostic value of tumor and plasma T790M mutations in EGFR TKI-treated advanced NSCLC. Ther Adv Med Oncol 2024; 16:17588359231222604. [PMID: 38249338 PMCID: PMC10799606 DOI: 10.1177/17588359231222604] [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] [Received: 02/22/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Background Substitution of methionine for threonine at codon 790 (T790M) of epidermal growth factor receptor (EGFR) represents the major mechanism of resistance to EGFR tyrosine kinase inhibitors (TKIs) in EGFR-mutant non-small-cell lung cancer. We determined the prognostic impact and association of secondary T790M mutations with the outcomes of osimertinib and chemotherapy. Methods Patients (n = 460) progressing from first-line EGFR-TKI treatment were assessed. Tissue and/or liquid biopsies were used to determine T790M status; post-progression overall survival (OS) was analyzed. Results Overall, 143 (31.1%) patients were T790M positive, 95 (20.7%) were T790M negative, and 222 (48.2%) had unknown T790M status. T790M status [T790M positive versus T790M negative: hazard ratio (HR) 0.48 (95% confidence interval (CI), 0.32-0.70); p < 0.001, T790M unknown versus T790M negative: HR 1.97 (95% CI, 1.47-2.64); p < 0.001] was significantly associated with post-progression OS. T790M positivity rates were similar for tissue (90/168, 53.6%) and liquid (53/90, 58.9%) biopsies (Fisher's exact test, p = 0.433). Tumor T790M-positive patients had significantly longer post-progression OS than tumor T790M-negative patients (34.1 versus 17.1 months; log-rank test, p = 8 × 10-5). Post-progression OS was similar between plasma T790M-positive and -negative patients (17.4 versus not reached; log-rank test, p = 0.600). In tumor T790M-positive patients, post-progression OS was similar after osimertinib and chemotherapy [34.1 versus 29.1 months; log-rank test, p = 0.900; HR 1.06 (95% CI, 0.44-2.57); p = 0.897]. Conclusion T790M positivity predicts better post-progression OS than T790M negativity; tumor T790M positivity has a stronger prognostic impact than plasma T790M positivity. Osimertinib and chemotherapy provide similar OS benefits in patients with T790M-positive tumors.
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Affiliation(s)
- Pi-Hung Tung
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Jia-Shiuan Ju
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Chi-Hsien Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - How-Wen Ko
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Fu-Tsai Chung
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Yi-Ke Guo
- Data Science Institute, Department of Computing, Imperial College London, London, UK
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 199, Tun-Hwa North Road, Taipei 333, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center
- Data Science Institute, Department of Computing, Imperial College London, London, UK
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
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Ju JS, Huang ACC, Tung PH, Huang CH, Chiu TH, Wang CC, Ko HW, Chung FT, Hsu PC, Fang YF, Guo YK, Kuo CHS, Yang CT. Brain metastasis, EGFR mutation subtype and generation of EGFR-TKI jointly influence the treatment outcome of patient with EGFR-mutant NSCLC. Sci Rep 2023; 13:20323. [PMID: 37989860 PMCID: PMC10663477 DOI: 10.1038/s41598-023-45815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation is brain metastasis (BM)-prone. We determined the impact of this hallmark, along with EGFR subtype and generation of tyrosine kinase inhibitor (TKI) treatment, on patients' outcome. 553 metastatic EGFR-mutant NSCLC patients received front-line EGFR-TKI treatment. Progression-free survival (PFS), overall survival (OS) and secondary T790M rate were analysed. BM was observed in 211 (38.2%) patients. BM (HR 1.20 [95% CI 0.99-1.48]; p = 0.053), ECOG PS 0-1 (HR 0.71 [95% CI 0.54-0.93]; p = 0.014) and afatinib treatment (HR 0.81 [95% CI 0.66-0.99]; p = 0.045) were associated with PFS. Afatinib-treated patients without BM demonstrated a significantly longer PFS (16.3 months) compared to afatinib-treated patients with BM (13.7 months) and to gefitinib/erlotinib-treated patients with (11.1 months) or without BM (14.2 months; p < 0.001). CNS-only progression trended higher in afatinib-treated patients. ECOG PS 0-1 (HR 0.41 [95% CI 0.31-0.56]; p < 0.001) and EGFR L858R mutation (HR 1.46 [95% CI 1.13-1.88]; p = 0.003), but not BM, were the predictors for OS. BM (OR 2.02 [95% CI 1.02-4.08]; p = 0.040), afatinib treatment (OR 0.26 [95% CI 0.12-0.50]; p < 0.001) and EGFR L858R mutation (OR 0.55 [95% CI 0.28-1.05]; p = 0.070) were associated with secondary T790M rate. In BM patients, gefitinib/erlotinib-treated ones with 19 deletion mutation and afatinib-treated ones with L858R mutation had the highest and the lowest T790M rate (94.4% vs. 27.3%, p < 0.001), respectively. BM and generation of EGFR-TKI jointly impact PFS and secondary T790M rate in patients with EGFR-mutant NSCLC, whereas OS was mainly associated with EGFR subtype.
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Affiliation(s)
- Jia-Shiuan Ju
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Pi-Hung Tung
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Chi-Hsien Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - How-Wen Ko
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Fu-Tsai Chung
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Yi-Ke Guo
- Data Science Institute, Department of Computing, Imperial College London, London, UK
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan.
- Data Science Institute, Department of Computing, Imperial College London, London, UK.
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
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Hsu PC, Huang CY, Lin YC, Lee SH, Chiu LC, Wu CE, Kuo SCH, Ju JS, Huang ACC, Ko HW, Wang CC, Yang CT. Sequential treatment in advanced epidermal growth factor receptor-mutated lung adenocarcinoma patients receiving first-line bevacizumab combined with 1st/2nd-generation EGFR-tyrosine kinase inhibitors. Front Oncol 2023; 13:1249106. [PMID: 37854677 PMCID: PMC10579797 DOI: 10.3389/fonc.2023.1249106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction The clinical outcomes of sequential treatment of advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) patients with first-line bevacizumab combined with 1st/2nd-generation EGFR-TKIs are unclear. Thus, we aimed to analyze the outcomes of these patients. Methods Between January 2015 and December 2020, data for 102 advanced EGFR-mutated lung adenocarcinoma patients receiving first-line bevacizumab combined with erlotinib or afatinib followed by treatments at multiple institutions were retrospectively analyzed. All patients with progressive disease (PD) after first-line therapy underwent secondary T790M mutation detection. Results The secondary T790M mutation positive rate of all study patients was 57.9%. First-line erlotinib use and progression-free survival (PFS) after first-line therapy > 12 months were positively associated with the T790M mutation (P <0.05). The response rates (RRs) to second-line treatments were 51.7% and 22.7% for the osimertinib and nonosimertinib groups, respectively (P = 0.001). The median PFS associated with second-line osimertinib and nonosimertinib therapy was 13.7 and 7.1 months, respectively (hazard ratio (HR) = 0.38; 95% confidence interval (CI), 0.23-0.63; P< 0.001). Patients with a secondary T790M mutation receiving second-line osimertinib treatment had a median overall survival (OS) of 54.3 months, and the median OS was 31.9 months for non-T790M-mutated patients receiving second-line nonosimertinib treatments (HR = 0.36; CI: 0.21-0.62, P < 0.001). Conclusion The majority of acquired resistance to first-line bevacizumab combined with 1st/2nd-generation EGFR-TKIs is associated with the T790M mutation. Sequential osimertinib treatment in patients with positive secondary T790M mutation is associated with better outcomes among these patients.
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Affiliation(s)
- Ping-Chih Hsu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yao Huang
- Department of Pulmonary and Critical Care, Buddhist Tzu Chi General Hospital, New Taipei City, Taiwan
| | - Yu-Ching Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi County, Taiwan
| | - Suey-Haur Lee
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Chung Chiu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-En Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Scott Chih-Hsi Kuo
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-Shiuan Ju
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ho-Wen Ko
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chou Wang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Ta Yang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hsu PC, Chiu LC, Chen KT, Wang CC, Wu CT, Wu CE, Ko HW, Kuo SCH, Lin YC, Wang CC, Yang CT. Clinical outcome analysis of non-small cell lung cancer patients with brain metastasis receiving metastatic brain tumor resection surgery: a multicenter observational study. Am J Cancer Res 2023; 13:3607-3617. [PMID: 37693127 PMCID: PMC10492134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/15/2023] [Indexed: 09/12/2023] Open
Abstract
Brain metastasis is most common in primary non-small cell lung cancer (NSCLC), and some patients require neurosurgical resection for intracranial disease control. Because advances in systemic therapies for metastatic NSCLC have been developed in the past decade, we aimed to analyze and determine clinical factors associated with the postresection survival of NSCLC patients with brain metastasis who underwent neurosurgery followed by systemic therapy. Between January 2017 and December 2021, data for 93 NSCLC patients with brain metastasis treated with neurosurgery followed by systemic therapy at Linkou, Kaohsiung and Chiayi Chang Gung Memorial Hospitals were retrospectively retrieved for analysis. For all study patients, median postresection survival was 34.36 months (95% confidence interval (CI), 28.97-39.76), median brain metastasis (BM)-free survival was 26.90 months (95% CI, 22.71-31.09), and overall survival (OS) was 41.13 months (95% CI, 34.47-47.52). In multivariate analysis, poor performance status (Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2) and concurrent liver metastasis were identified as independent unfavorable factors associated with significantly shortened postresection survival (P<0.001). The histological type adenocarcinoma was associated with significantly longer postresection survival (P = 0.001). The median postresection survival for adenocarcinoma and nonadenocarcinoma patients was 36.23 and 10.30 months, respectively (hazard ratio (HR) = 0.122; 95% CI, 0.035-0.418; P<0.001); that for patients with and without concurrent liver metastasis was 11.43 and 36.23 months, respectively (HR = 22.18; 95% CI, 5.827-84.459; P<0.001). Patients with preserved ECOG PS, adenocarcinoma histology type and no concurrent liver metastasis appeared to have better postresection survival than nonadenocarcinoma patients. Our results provide counseling and decision-making references for neurosurgery feasibility in NSCLC patients with brain metastasis.
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Affiliation(s)
- Ping-Chih Hsu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
| | - Li-Chung Chiu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
| | - Ko-Ting Chen
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
| | - Chun-Chieh Wang
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
- Division of Radiation Oncology, Chang Gung Memorial Hospital Linkou BranchTaoyuan 33305, Taiwan
| | - Chen-Te Wu
- Department of Radiology, Chang Gung Memorial Hospital Linkou BranchTaoyuan 33305, Taiwan
| | - Chiao-En Wu
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
| | - Ho-Wen Ko
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
| | - Scott Chih-Hsi Kuo
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
| | - Yu-Ching Lin
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
- Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial HospitalChiayi Branch, Chiayi County 613, Taiwan
| | - Chin-Chou Wang
- Department of Medicine, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301, Taiwan
| | - Cheng-Ta Yang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouTaoyuan 33305, Taiwan
- Department of Internal Medicine, Taoyuan Chang Gung Memorial HospitalTaoyuan 33378, Taiwan
- Department of Respiratory Therapy, College of Medicine, Chang Gung UniversityTaoyuan 33302, Taiwan
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Kuo CHS, Su PL, Wei YF, Ko JC, Tseng JS, Su J, Chiang CL, Chen CY, Lin CC, Wang CC, Ho CC, Chang HC, Hung JY. T790M detection rate after first-line combination therapy with bevacizumab and EGFR-TKIs in advanced NSCLC (TERRA Study). Am J Cancer Res 2023; 13:3100-3112. [PMID: 37559987 PMCID: PMC10408489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 08/11/2023] Open
Abstract
Real-world data regarding the T790M mutation rate after acquiring resistance to first-line combination therapy with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and bevacizumab in patients with advanced non-small-cell lung cancer (NSCLC) are limited. The present study was aimed at analyzing predictors of acquired T790M mutations in this patient group. A total of 107 patients who received first-line combination therapy with EGFR-TKIs and bevacizumab at 11 tertiary referral centers in Taiwan were enrolled in this multicenter retrospective study. Survival data and genomic test results after acquiring resistance were analyzed. We discovered that patients who received a combination of afatinib, a second generation EGFR-TKI, and bevacizumab showed better progression-free survival (PFS). After disease progression, 59 patients (55.1%) were confirmed to test positive for EGFR T790M. A longer duration of first-line therapy could be a predictor of subsequent T790M mutations. To our knowledge, this is one of the few and early studies to demonstrate the T790M mutation rate after first-line combination therapy with an EGFR-TKI and bevacizumab. Whether the longer PFS afforded by the addition of bevacizumab could lead to subsequent T790M mutations needs further investigation.
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Affiliation(s)
- Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, Linkou Chang Gung Memorial HospitalTaoyuan 333, Taiwan
- Chang Gung University College of MedicineTaoyuan 333, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan 701, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine, E-Da Cancer Hospital, I-Shou UniversityKaohsiung 807, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou UniversityKaohsiung 807, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu BranchHsinchu 300, Taiwan
| | - Jeng-Sen Tseng
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing UniversityTaichung 402, Taiwan
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General HospitalTaichung 407, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing UniversityTaichung 402, Taiwan
- College of Medicine, National Yang Ming Chiao Tung UniversityTaipei 112, Taiwan
| | - Jian Su
- Chest Division, Department of Internal Medicine, MacKay Memorial HospitalTaipei 100, Taiwan
| | - Chi-Lu Chiang
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General HospitalTaipei 112, Taiwan
| | - Chung-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital Yunlin BranchYunlin 640, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityTaipei 100, Taiwan
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan 701, Taiwan
- Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan 701, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung UniversityTainan 701, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung 807, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung 807, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and TechnologyChiayi 600, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University HospitalTaipei 100, Taiwan
- College of Medicine, National Taiwan UniversityTaipei 100, Taiwan
| | - Huang-Chih Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung 807, Taiwan
| | - Jen-Yu Hung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung 807, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical UniversityKaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical UniversityKaohsiung 807, Taiwan
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Hsu PC, Chang JWC, Chang CF, Huang CY, Yang CT, Kuo CHS, Fang YF, Wu CE. Sequential treatment in advanced non-small cell lung cancer harboring EGFR mutations. Ther Adv Respir Dis 2022; 16:17534666221132731. [PMID: 36305280 PMCID: PMC9619270 DOI: 10.1177/17534666221132731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are standard treatments for advanced EGFR-mutated non-small cell lung cancer (NSCLC) patients. Osimertinib is an effective therapy for NSCLC patients with acquired resistance due to T790M mutation after first- and second-generation EGFR-TKI treatment. This study aimed to analyze the clinical outcomes of sequential therapy following first-line EGFR-TKIs and the predictive factors of an acquired T790M mutation. METHODS Between January 2014 and December 2018, data from 2190 advanced NSCLC patients with common EGFR mutations (exon 19 deletion and L858R) receiving first- and second-generation EGFR-TKIs in Linkou, Kaohsiung, Chiayi and Keelung Chang Gung Memorial Hospitals were retrospectively retrieved and analyzed. RESULTS Until August 2021, among 1943 patients who experienced progressive disease, 526 underwent T790M mutation tests, and their T790M-positive rate was 53.6%. Exon 19 deletion mutation and progression-free survival (PFS) of >12 months were positively associated with secondary T790M mutation. Different first-line first- and second-generation EGFR-TKI therapies did not affect the appearance of acquired T790M mutations. The median overall survival (OS) was 58.3 [95% confidence interval (CI): 49.0-67.5] months among the patients with T790M mutation who received second-line osimertinib therapy compared with 31.0 (95% CI: 27.5-34.5) months among the patients without T790M mutation who received chemotherapy alone. The multivariate analysis showed that a poor performance status (score: >2), nonadenocarcinoma histology, stage IV cancer, liver metastasis, brain metastasis, PFS while on first-line EGFR-TKIs, and subsequent chemotherapy without third-generation EGFR-TKIs were significant independent unfavorable prognostic factors for OS. CONCLUSION This study demonstrated the efficacy of first-line EGFR-TKIs and sequential osimertinib therapy. The results of our study suggest that T790M mutation tests are important for the use of subsequent osimertinib, which yielded favorable survival outcomes.
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Affiliation(s)
- Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ching-Fu Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Yang Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan,Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan City, Taiwan,Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Impact of T790M Mutation Status on Later-Line Osimertinib Treatment in Non-Small Cell Lung Cancer Patients. Cancers (Basel) 2022; 14:cancers14205095. [PMID: 36291877 PMCID: PMC9600420 DOI: 10.3390/cancers14205095] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Osimertinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) designed to overcome acquired T790M resistance mutations in non-small cell lung cancer (NSCLC). However, the efficacy of osimertinib in patients without acquired T790M mutations has not been well studied. This study aimed to evaluate the efficacy of osimertinib in patients treated with first- and second-generation EGFR-TKIs followed by later-line osimertinib treatment. Patients: The clinical data and survival outcomes of 172 patients with advanced NSCLC treated with osimertinib following frontline EGFR-TKIs at Chang Gung Memorial Hospital from 2014 to 2018 were retrospectively reviewed. T790M mutations were detected using tissue sequencing and/or liquid biopsy. Results: A total of 172 EGFR-mutated NSCLC patients treated with frontline EGFR-TKI therapy followed by later-line osimertinib were enrolled in the current study and divided into three groups based on the T790M status (positive, negative, or unknown T790M). Patients with NSCLC harboring acquired T790M mutation treated with osimertinib had the best objective response rate (ORR) (52.6%, 25.0%, and 32.0%, p = 0.044), disease control rate (DCR) (79.3%, 41.7%, and 68.0%, p = 0.011), and progression-free survival (PFS, median PFS, 12.6, 3.1, 10.4 months, p = 0.001) among the three groups (positive, negative, and unknown T790M, respectively). However, a marked difference was found between positive and negative T790M mutations but not between positive and unknown T790M mutations. Univariate analysis was performed to identify potential prognostic factors for PFS in 172 patients treated with osimertinib. Lung metastasis (p < 0.001), brain metastasis (p < 0.009), number of metastatic sites (p < 0.001), PFS with frontline EGFR-TKIs (p = 0.03), and T790M status (p = 0.006) were identified as prognostic factors for PFS with osimertinib. Multivariate analysis showed that lung metastasis (p < 0.001) and PFS with frontline EGFR-TKIs and T790M status were independent prognostic factors. Conclusion: This study confirmed the greater efficacy of later-line osimertinib for NSCLC with acquired T790M mutation than for NSCLC without acquired T790M mutation. Detection of the T790M mutation after frontline treatment (first- and second-generation EGFR-TKI) is crucial for prolonging the survival of NSCLC patients harboring EGFR mutation. Osimertinib may be considered an option for NSCLC with unknown T790M mutations, as a certain subpopulation may benefit from osimertinib.
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10
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Lee SH, Lin YC, Chiu LC, Ju JS, Tung PH, Huang ACC, Li SH, Fang YF, Chen CH, Kuo SCH, Wang CC, Yang CT, Hsu PC. Comparison of afatinib and erlotinib combined with bevacizumab in untreated stage IIIB/IV epidermal growth factor receptor-mutated lung adenocarcinoma patients: a multicenter clinical analysis study. Ther Adv Med Oncol 2022; 14:17588359221113278. [PMID: 35898964 PMCID: PMC9310205 DOI: 10.1177/17588359221113278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although bevacizumab in combination with afatinib or erlotinib is an effective and safe first-line therapy for advanced epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC), there are very few clinical data comparing afatinib and erlotinib combined with bevacizumab. We performed a retrospective multicenter analysis for the comparison of two combination therapies. Methods: Between May 2015 and October 2020, data of 135 stage IIIB/IV EGFR-mutated NSCLC patients receiving first-line afatinib or erlotinib combined with bevacizumab combination therapy in Linkou, Keelung, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals were retrieved and retrospectively analyzed. Results: In all, 67 patients received afatinib plus bevacizumab, and 68 patients received erlotinib plus bevacizumab. Afatinib combined with bevacizumab had an objective response rate (ORR) of 82.1% and a disease control rate (DCR) of 97.0%, and the ORR and DCR were 83.8 and 95.6%, respectively, in the erlotinib combined with bevacizumab group (p = 0.798 and p = 1.000). The median progression-free survival was 20.7 and 20.3 months for the afatinib plus bevacizumab group and the erlotinib plus bevacizumab group, respectively [hazard ratio (HR) = 1.02; 95% confidence interval (CI), 0.891–1.953; p = 0.167). The overall survival was 41.9 and 51.0 months for the afatinib plus bevacizumab group and erlotinib plus bevacizumab group, respectively (HR = 1.42; 95% CI, 0.829–2.436; p = 0.201). The secondary EGFR-T790M mutation rates after disease progression were 44% in the afatinib plus bevacizumab group and 58.8% in the erlotinib plus bevacizumab group (p = 0.165). Skin toxicity was the most frequent treatment-related adverse event (AE) in both treatment groups. Diarrhea, an AE, occurred significantly more frequently in the afatinib plus bevacizumab group than in the erlotinib plus bevacizumab group (p < 0.05). Conclusion: Afatinib combined with bevacizumab was equally as effective as erlotinib combined with bevacizumab for untreated advanced EGFR-mutated NSCLC. Prospective clinical studies that explore bevacizumab combined with afatinib or erlotinib for advanced EGFR-mutated NSCLC are warranted.
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Affiliation(s)
- Suey-Haur Lee
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
| | - Yu-Ching Lin
- Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi City
| | - Li-Chung Chiu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
| | - Jia-Shiuan Ju
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City
| | - Pi-Hung Tung
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City
| | - Allen Chung-Cheng Huang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City
| | - Shih-Hong Li
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City
| | - Yueh-Fu Fang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City
| | - Chih-Hung Chen
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City
| | - Scott Chih-Hsi Kuo
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
| | - Cheng-Ta Yang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City
| | - Ping-Chih Hsu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
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11
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The Difference in Clinical Outcomes Between Osimertinib and Afatinib for First-Line Treatment in Patients with Advanced and Recurrent EGFR-Mutant Non-Small Cell Lung Cancer in Taiwan. Target Oncol 2022; 17:295-306. [PMID: 35460474 PMCID: PMC9633524 DOI: 10.1007/s11523-022-00878-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/04/2022]
Abstract
Background Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors are the standard first-line treatment for patients with advanced and recurrent EGFR-positive non-small cell lung cancer. Objective The main objective of the present study was to compare the clinical efficacies between osimertinib and afatinib as first-line treatment in patients with EGFR-mutant non-small cell lung cancer. Methods We retrospectively analyzed patients with advanced and recurrent non-small cell lung cancer who harbored an exon 19 deletion or an exon 21 L858R mutation and were being given either osimertinib or afatinib as first-line treatment from January 2018 to December 2020. Results A total of 128 patients were selected for this study. The osimertinib group included 47 patients, while 81 patients received afatinib. The median follow-up time was 20.1 months in the osimertinib group and 22.7 months in the afatinib group. The median progression-free survival was 18.8 months and 13.1 months in the osimertinib and afatinib groups, respectively (hazard ratio 0.75 [95% confidence interval 0.48–1.18]). The median overall survival was not reached in the osimertinib group and was 41.7 months in the afatinib group (hazard ratio 0.79 [95% confidence interval 0.36–1.72]). In patients without brain metastasis, the median progression-free survival was 17.9 months and 17.2 months in the osimertinib and afatinib groups, respectively (hazard ratio 1.02 [95% confidence interval 0.56–1.85]). In patients with brain metastasis at baseline, the median progression-free survival was 22.1 months in the osimertinib group, and 10.9 months in the afatinib group (adjusted hazard ratio 0.45 [95% confidence interval 0.21–0.96]). Conclusions Our research demonstrates that there was no strong evidence showing that patients taking osimertinib as first-line treatment experienced longer median progression-free survival and overall survival than patients treated with afatinib. However, there was a statistical significance revealing that osimertinib provided better median progression-free survival than afatinib in patients with brain metastasis at baseline.
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12
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Chiu TH, Tung PH, Huang CH, Ju JS, Huang ACC, Wang CC, Ko HW, Hsu PC, Fang YF, Guo YK, Kuo CHS, Yang CT. The different overall survival between single-agent EGFR-TKI treatment and with bevacizumab in non-small cell lung cancer patients with brain metastasis. Sci Rep 2022; 12:4398. [PMID: 35292755 PMCID: PMC8924189 DOI: 10.1038/s41598-022-08449-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Comparison of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) monotherapy or with bevacizumab in real-world non-small cell lung cancer (NSCLC) patients was lacking. 310 patients of advanced NSCLC with common EGFR mutation receiving first-generation EGFR-TKI monotherapy or with bevacizumab were included and propensity-score matched. Progression-free survival (PFS), overall survival (OS) and secondary T790M mutation were analysed. Patients receiving EGFR-TKI and bevacizumab were significantly younger, had better performance status and with high incidence of brain metastasis (55.8%). In the propensity-score matched cohort, PFS (13.5 vs. 13.7 months; log-rank p = 0.700) was similar between the two groups. The OS (61.3 vs. 34.2 months; log-rank p = 0.010) and risk reduction of death (HR 0.42 [95% CI 0.20–0.85]; p = 0.017) were significantly improved in EGFR-TKI plus bevacizumab group. Analysis of treatment by brain metastasis status demonstrated EGFR-TKI plus bevacizumab in patients with brain metastasis was associated with significant OS benefit compared to other groups (log-rank p = 0.030) and these patients had lower early-CNS and early-systemic progressions. The secondary T790M did not significantly differ between EGFR-TKI plus bevacizumab and EGFR-TKI monotherapy groups (66.7% vs. 75.0%, p = 0.460). Forty-one (31.1%) and 31 (23.5%) patients received subsequent osimertinib and chemotherapy, respectively. The post-progression OS of osimertinib and chemotherapy were 22.1 and 44.9 months in EGFR-TKI plus bevacizumab group and were 10.0 and 14.1 months in EGFR-TKI monotherpay group, respectively. First-generation EGFR-TKI with bevacizumab improved treatment efficacy in real-world patients of NSCLC with EGFR mutation. Patients with brain metastasis received additional OS benefit from this treatment.
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Affiliation(s)
- Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Pi-Hung Tung
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chi-Hsien Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Jia-Shiuan Ju
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ho-Wen Ko
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yi-Ke Guo
- Department of Computing, Data Science Institute, Imperial College London, London, UK
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan. .,Department of Computing, Data Science Institute, Imperial College London, London, UK.
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
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