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Pham VL, Le TA, Pham CP, Hoa Nguyen TT, Do AT, Nguyen TK, Nguyen MH, Thu Hoang TA, Hao Vuong DT, Tam Nguyen DN, Khiem Dang V, Nguyen TO, Trang Vo TH, Do HK, Vu HT, Nguyen TTH, Pham VT, Trinh LH, Dung Nguyen K, Nguyen HG, Truong CM, Chau Pham TM, Nguyen TBP. Real-world analysis of afatinib as a first-line treatment for patients with advanced stage non-small-cell lung cancer with uncommon EGFR mutations: a multicenter study in Vietnam. Ther Adv Med Oncol 2024; 16:17588359241242972. [PMID: 38736554 PMCID: PMC11085022 DOI: 10.1177/17588359241242972] [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: 07/15/2023] [Accepted: 03/11/2024] [Indexed: 05/14/2024] Open
Abstract
Background Afatinib is indicated for advanced-stage non-small-cell lung cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) and uncommon mutations. However, real-world studies on this topic are limited. This study aimed to evaluate afatinib as first-line therapy for locally advanced and metastatic NSCLC with uncommon EGFR mutations. Patients and methods A retrospective study included 92 patients with advanced NSCLC with uncommon and compound EGFR mutations, treated with afatinib as first-line therapy. Patients were followed up and evaluated every 3 months or when symptoms of progressive disease arose. The endpoints were objective response rate (ORR), time-to-treatment failure (TTF), and adverse events. Results The G719X EGFR mutation had the highest occurrence rate (53.3% for both monotherapy and the compound). By contrast, the compound mutation G719X-S768I was observed at a rate of 22.8%. The ORR was 75%, with 15.2% of patients achieving complete response. The overall median TTF was 13.8 months. Patients with the G719X EGFR mutation (single and compound) had a median TTF of 19.3 months, longer than that of patients with other mutations, who had a median TTF of 11.2 months. Patients with compound EGFR mutations (G719X and S768I) demonstrated a median TTF of 23.2 months compared to that of 12.3 months for other mutations. Tolerated doses of 20 or 30 mg achieved a longer median TTF of 17.1 months compared to 11.2 months with 40 mg. Median TTF differed between patients with and without brain metastasis, at 11.2 and 16.9 months, respectively. Rash (55.4%) and diarrhea (53.3%) were the most common adverse events, primarily grades 1 and 2. Other side effects occurred at a low rate. Conclusion Afatinib is effective for locally advanced metastatic NSCLC with uncommon EGFR mutations. Patients with G719X, compound G719X-S768I mutations, and tolerated doses of 20 or 30 mg had a longer median TTF than those with other mutations.
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Affiliation(s)
- Van Luan Pham
- 108 Military Central Hospital, Hanoi, Hai Ba Trung, Vietnam
| | - Tuan Anh Le
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City 72760, Vietnam
| | | | | | - Anh Tu Do
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | | | | | | | | | | | | | | | | | - Hung Kien Do
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Ha Thanh Vu
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | | | - Van Thai Pham
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Le Huy Trinh
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
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Pham CP, Nguyen TTH, Do AT, Nguyen TK, Hoang TAT, Le TA, Vuong DTH, Nguyen DNT, Dang VK, Nguyen TO, Pham VL, Nguyen MH, Vo THT, Do HK, Vu HT, Nguyen TTH, Pham VT, Trinh LH, Nguyen KD, Nguyen HG, Truong CM, Pham TMC, Nguyen TBP. A real-world cohort study of first-line afatinib in patients with EGFR-mutant advanced non-small cell lung cancer in Vietnam. BMC Cancer 2024; 24:176. [PMID: 38317094 PMCID: PMC10840225 DOI: 10.1186/s12885-024-11891-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: 09/29/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and side effects of first-line afatinib treatment in a real-world setting in Vietnam. METHODS This retrospective study was conducted across nine hospitals in Vietnam. Advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients who received afatinib as first-line therapy between April 2018 and June 2022 were included, and patient medical records were reviewed. Key outcomes were overall response rate (ORR), time-to-treatment failure (TTF), and tolerability. RESULTS A total of 343 patients on first-line afatinib were eligible for the study. EGFR exon 19 deletion (Del19) alone was detected in 46.9% of patients, L858R mutation alone in 26.3%, and other uncommon EGFR mutations, including compound mutations, in 26.8%. Patients with brain metastases at baseline were 25.4%. Patients who received 40 mg, 30 mg, and 20 mg as starting doses of afatinib were 58.6%, 39.9%, and 1.5%, respectively. The ORR was 78.1% in the overall population, 82.6% in the Del19 mutation subgroup, 73.3% in the L858R mutation subgroup, and 75.0% in the uncommon mutation subgroup (p > 0.05). The univariate and multivariate analyses indicate that the ORR increased when the starting dose was 40 mg compared to starting doses below 40 mg (83.9% vs. 74.3%, p = 0.034). The median TTF (mTTF) was 16.7 months (CI 95%: 14.8-18.5) in all patients, with a median follow-up time of 26.2 months. The mTTF was longer in patients in the common EGFR mutation subgroup (Del19/L858R) than in those in the uncommon mutation subgroup (17.5 vs. 13.8 months, p = 0.045) and in those without versus with brain metastases at baseline (17.5 vs. 15.1 months, p = 0.049). There were no significant differences in the mTTF between subgroups based on the starting dose of 40 mg and < 40 mg (16.7 vs. 16.9 months, p > 0.05). The most common treatment-related adverse events (any grade/grade ≥ 3) were diarrhea (55.4%/3.5%), rash (51.9%/3.2%), paronychia (35.3%/5.0%), and stomatitis (22.2%/1.2%). CONCLUSIONS Afatinib demonstrated clinical effectiveness and good tolerability in Vietnamese EGFR-mutant NSCLC patients. In our real-world setting, administering a starting dose below 40 mg might result in a reduction in ORR; however, it might not have a significant impact on TTF.
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Affiliation(s)
| | | | - Anh Tu Do
- Vietnam National Cancer Hospital, Hanoi, Vietnam.
| | | | | | | | | | | | | | | | | | | | | | - Hung Kien Do
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Ha Thanh Vu
- Vietnam National Cancer Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | | | - Van Thai Pham
- Bach Mai Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
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Cosso F, Roviello G, Catalano M, Botteri C, Comin CE, Castiglione F, Ferrari K, Baldini E, Mini E. A case report of a lung cancer patient with two uncommon EGFR mutations and a review of the literature: two sides of the same coin. Anticancer Drugs 2024; 35:76-80. [PMID: 37067984 DOI: 10.1097/cad.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Lung cancer is the malignancy with the highest morbidity and mortality worldwide. Approximately 60% of non-small cell lung cancer (NSCLC) presents driver alterations most of which are targetable. Nowadays, limited clinical data are available regarding the efficacy of epithelial growth factor receptor (EGFR) tyrosine kinase inhibitors in patients with NSCLC harboring uncommon EGFR mutations, considering their heterogeneity. Herein, we report a rare case of EGFR-mutated lung adenocarcinoma which has developed into squamous cell carcinoma with uncommon EGFR (Ex18) compound mutations and phosphatidylinositol 3-kinase mutation receiving afatinib at the forefront.
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Affiliation(s)
| | | | | | | | - Camilla Eva Comin
- Pathological Histology and Molecular Diagnostics Unit, Careggi University Hospital
| | | | - Katia Ferrari
- Respiratory Medicine Unit, Careggi University Hospital, Florence
| | - Editta Baldini
- Department of Medical Oncology, San Luca Hospital, Lucca, Italy
| | - Enrico Mini
- Department of Health Sciences, University of Florence
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Wang Q, Wang Y, Zhang X, Fang C, Qian X, Li Y. Efficacy of erlotinib in NSCLC harboring rare EGFR extracellular domain mutation (T263P) and common mutations: Case report and literature review. Front Oncol 2022; 12:954026. [PMID: 36212397 PMCID: PMC9539819 DOI: 10.3389/fonc.2022.954026] [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] [Received: 05/26/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) typically contains an extracellular domain (ECD), a transmembrane (TM) domain, and an intracellular kinase (KD) domain. ECD mutations of EGFR in NSCLC may affect its normal function and intrinsic resistance to tyrosine kinase inhibitors (TKIs) and the effectiveness of drugs for these patients is unsatisfactory. Recently, we found an EGFR T263P mutation located at the ECD, which has never been reported in Chinese non-small cell lung cancer (NSCLC). Hence, we reported that a patient with advanced lung adenocarcinoma harboring the EGFR T263P mutation, L858R mutation and MET amplification was resistant to osimertinib but significantly benefited from erlotinib and capmatinib treatment. This patient achieved a partial response and had progression-free survival (PFS) for more than 19 months. In summary, we are the first researchers to report in detail on a Chinese patient carrying the T263P mutation and summarize all the ECD mutations in NSCLC. We believe this finding will enlighten us to treat patients with EGFR ECD mutations and more patients deserve further study.
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Affiliation(s)
- Qian Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinwei Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen Fang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoying Qian
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yong Li,
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