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Which Is Better EGFR-TKI Followed by Osimertinib: Afatinib or Gefitinib/Erlotinib?
Anticancer Res 2019; 39(7):3923-3929AR

Abstract

BACKGROUND/AIM

Treatment with EGFR-tyrosine kinase inhibitor (TKI) shows a durable response against NSCLC harboring EGFR mutation; however, treatment resistance occurs within 1-1.5 years following first-line EGFR-TKIs [first- and second-generation (G) TKIs]. When resistant NSCLC exhibits T790M mutations, osimertinib is the standard therapy. However, intratumoral heterogeneity and clonal evolution may occur in NSCLC. Afatinib may overcome tumor heterogeneity, leading to T790M colonal purity. We aimed to determine whether NSCLC treatment with afatinib followed by osimertinib (afatinib group) provides higher therapeutic efficacy than other 1st-G EFGR-TKIs followed by osimertinib (1st-G group).

MATERIALS AND METHODS

This multicenter retrospective study evaluated outcomes between afatinib group and 1st-G group. We analyzed clinical data from NSCLC patients receiving osimertinib after progression following 1st- or 2nd-G EGFR-TKIs between March 28, 2016 and March 31, 2018. Patients with performance status (PS) 0-2 were enrolled to reduce bias of patients' conditions.

RESULTS

We enrolled 111 patients treated with osimertinib. The median age was 69 (range: 39-88) years. Out of 111 patients, 33 (29.7%) were men, 100 (90%) had PS 0-1, and 35 (31.5%) were in the afatinib group. The objective RR and DCR were significantly higher in the afatinib group than in the 1st-G group [82.9% vs. 53.9% (p=0.0065); 91.4% vs. 71.1% (p=0.032)]. The median PFS tended higher in the afatinib group than in the 1st-G group (15.6 vs. 8.9 months, p=0.195).

CONCLUSION

Afatinib followed by osimertinib may provide better outcomes for T790M-positive NSCLC than 1st-G EGFR-TKIs. Afatinib followed by osimertinib may be a therapeutic option for NSCLC harboring EGFR mutation.

Authors+Show Affiliations

Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan moto19781205@yahoo.co.jp.Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan.Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan.Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan.Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan.Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan.Clinical Research Center, Kinki-chuo Chest Medical Center, Sakai, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31262922

Citation

Tamiya, Motohiro, et al. "Which Is Better EGFR-TKI Followed By Osimertinib: Afatinib or Gefitinib/Erlotinib?" Anticancer Research, vol. 39, no. 7, 2019, pp. 3923-3929.
Tamiya M, Tamiya A, Suzuki H, et al. Which Is Better EGFR-TKI Followed by Osimertinib: Afatinib or Gefitinib/Erlotinib? Anticancer Res. 2019;39(7):3923-3929.
Tamiya, M., Tamiya, A., Suzuki, H., Moriizumi, K., Nakahama, K., Taniguchi, Y., ... Kumagai, T. (2019). Which Is Better EGFR-TKI Followed by Osimertinib: Afatinib or Gefitinib/Erlotinib? Anticancer Research, 39(7), pp. 3923-3929. doi:10.21873/anticanres.13544.
Tamiya M, et al. Which Is Better EGFR-TKI Followed By Osimertinib: Afatinib or Gefitinib/Erlotinib. Anticancer Res. 2019;39(7):3923-3929. PubMed PMID: 31262922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Which Is Better EGFR-TKI Followed by Osimertinib: Afatinib or Gefitinib/Erlotinib? AU - Tamiya,Motohiro, AU - Tamiya,Akihiro, AU - Suzuki,Hidekazu, AU - Moriizumi,Kazunori, AU - Nakahama,Kenji, AU - Taniguchi,Yoshihiko, AU - Kunimasa,Kei, AU - Kimura,Madoka, AU - Inoue,Takako, AU - Kuhara,Hanako, AU - Nishino,Kazumi, AU - Hirashima,Tomonori, AU - Atagi,Shinji, AU - Imamura,Fumio, AU - Kumagai,Toru, PY - 2019/04/08/received PY - 2019/04/28/revised PY - 2019/04/30/accepted PY - 2019/7/3/entrez PY - 2019/7/3/pubmed PY - 2019/7/10/medline KW - Afatinib KW - EGFR mutation KW - T790M KW - osimertinib KW - sequential TKI-therapy SP - 3923 EP - 3929 JF - Anticancer research JO - Anticancer Res. VL - 39 IS - 7 N2 - BACKGROUND/AIM: Treatment with EGFR-tyrosine kinase inhibitor (TKI) shows a durable response against NSCLC harboring EGFR mutation; however, treatment resistance occurs within 1-1.5 years following first-line EGFR-TKIs [first- and second-generation (G) TKIs]. When resistant NSCLC exhibits T790M mutations, osimertinib is the standard therapy. However, intratumoral heterogeneity and clonal evolution may occur in NSCLC. Afatinib may overcome tumor heterogeneity, leading to T790M colonal purity. We aimed to determine whether NSCLC treatment with afatinib followed by osimertinib (afatinib group) provides higher therapeutic efficacy than other 1st-G EFGR-TKIs followed by osimertinib (1st-G group). MATERIALS AND METHODS: This multicenter retrospective study evaluated outcomes between afatinib group and 1st-G group. We analyzed clinical data from NSCLC patients receiving osimertinib after progression following 1st- or 2nd-G EGFR-TKIs between March 28, 2016 and March 31, 2018. Patients with performance status (PS) 0-2 were enrolled to reduce bias of patients' conditions. RESULTS: We enrolled 111 patients treated with osimertinib. The median age was 69 (range: 39-88) years. Out of 111 patients, 33 (29.7%) were men, 100 (90%) had PS 0-1, and 35 (31.5%) were in the afatinib group. The objective RR and DCR were significantly higher in the afatinib group than in the 1st-G group [82.9% vs. 53.9% (p=0.0065); 91.4% vs. 71.1% (p=0.032)]. The median PFS tended higher in the afatinib group than in the 1st-G group (15.6 vs. 8.9 months, p=0.195). CONCLUSION: Afatinib followed by osimertinib may provide better outcomes for T790M-positive NSCLC than 1st-G EGFR-TKIs. Afatinib followed by osimertinib may be a therapeutic option for NSCLC harboring EGFR mutation. SN - 1791-7530 UR - https://www.unboundmedicine.com/medline/citation/31262922/Which_Is_Better_EGFR_TKI_Followed_by_Osimertinib:_Afatinib_or_Gefitinib/Erlotinib L2 - http://ar.iiarjournals.org/cgi/pmidlookup?view=long&pmid=31262922 DB - PRIME DP - Unbound Medicine ER -