Real-life comparison of afatinib and erlotinib in non-small cell lung cancer with rare EGFR exon 18 and exon 20 mutations: a Turkish Oncology Group (TOG) study.

Autor: Gursoy P; Ege University School of Medicine, Tulay Aktas Oncology Hospital, 35100, Izmir, Bornova, Turkey. pinargursoy77@gmail.com., Tatli AM; Akdeniz University School of Medicine, Antalya, Turkey., Erdem D; Samsun Medical Park, Samsun, Turkey., Goker E; Ege University School of Medicine, Tulay Aktas Oncology Hospital, 35100, Izmir, Bornova, Turkey., Celik E; Department of Medical Oncology, Cerrahpasa School of Medicine, Istanbul, Turkey., Demirci NS; Department of Medical Oncology, Cerrahpasa School of Medicine, Istanbul, Turkey., Sakin A; Department of Medical Oncology, Professor Doctor Cemil, Taşçıoğlu City Hospital, Istanbul, Turkey., Atci MM; Department of Medical Oncology, Professor Doctor Cemil, Taşçıoğlu City Hospital, Istanbul, Turkey., Bayram E; Department of Medical Oncology, Cukurova University, Adana, Turkey., Telli TA; Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey., Bilgin B; Department of Medical Oncology, Ataturk Chest Disease and Chest Surgery Research and Training Hospital, Ankara, Turkey., Bilici A; Medical Oncology, Medipol University, Istanbul, Turkey., Akangunduz B; Department of Medical Oncology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey., Balli S; Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey., Demirkazik A; Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey., Selçukbiricik F; Department of Medical Oncology, Koc University School of Medicine, Istanbul, Turkey., Menekse S; Department of Medical Oncology, Manisa City Hospital, Manisa, Turkey., Cavdar E; Department of Medical Oncology, Namık Kemal University, Tekirdağ, Turkey., Ozturk A; Clinic of Medical Oncology, University of Heath Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey., Bekmez ET; Health Sciences University Derince Education Research Hospital, Kocaeli, Turkey., Turhal S; Department of Medical Oncology, Anadolu Health Center, Istanbul, Turkey., Kilickap S; Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey., Yildirim HÇ; Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey., Oyan B; Department of Medical Oncology, Acıbadem Altunizade Hospital, İstanbul, Turkey., Aksoy A; Department of Medical Oncology, Fırat University, Elazığ, Turkey., Turkoz FP; Istinye University. Medical Park Goztepe Hospital, Istanbul, Turkey., Kut E; Department of Medical Oncology, Manisa City Hospital, Manisa, Turkey., Katgi N; Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey., Sakalar T; Department of Medical Oncology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey., Akyol M; Bakırçay University Cigli Education and Research Hospital, İzmir, Turkey., Ellez Hİ; Department of Medical Oncology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey., Topcu A; Department of Medical Oncology, Bezmialem Vakıf University, Istanbul, Turkey., Erdoğan AP; Medical Oncology Department, Celal Bayar University, Manisa, Turkey., Pilanci KN; Memorial Bahcelievler Hospital, Istanbul, Turkey., Hedem E; Necmettin Erbaka University, Konya, Turkey., Arak H; Department of Medical Oncology, Gaziantep University School of Medicine, Gazıantep, Turkey., Akdeniz N; Department of Medical Oncology, Adiyaman Training and Research Hospital, Adiyaman, Turkey., Alan Ö; Tekirdag City Hospital, Tekirdağ, Turkey., Yapar B; Department of Medical Oncology, Pamukkale University School of Medicine, Denizli, Turkey., Nart D; Ege University School of Medicine, Tulay Aktas Oncology Hospital, 35100, Izmir, Bornova, Turkey., Yumuk PF; Department of Medical Oncology, Koc University School of Medicine, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: Journal of cancer research and clinical oncology [J Cancer Res Clin Oncol] 2023 Feb; Vol. 149 (2), pp. 865-875. Date of Electronic Publication: 2022 Apr 05.
DOI: 10.1007/s00432-022-03984-5
Abstrakt: Objectives: To compare the survival of first- and second-generation tyrosine kinase inhibitors (TKIs) in patients with rare EGFR exon 18 and exon 20 mutation-positive non-small cell lung cancer (NSCLC).
Materials and Methods: We retrospectively evaluated survival characteristics of 125 patients with EGFR exon 18 and exon 20 mutated NSCLC who received erlotinib or afatinib as first line treatment between 2012 and 2021 from 34 oncology centres. Since exon 20 insertion is associated with TKI resistance, these 18 patients were excluded from the study.
Results: EGFR exon 18 mutations were seen in 60%, exon 20 mutations in 16%, and complex mutations in 24% of the patients with NSCLC who were evaluated for the study. There were 75 patients in erlotinib treated arm and 50 patients in afatinib arm. Patients treated with erlotinib had progression-free survival time (PFS) of 8.0 months and PFS was 7.0 months in the afatinib arm (p = 0.869), while overall survival time (OS) was 20.0 vs 24.8 months, respectively (p = 0.190). PFS of exon 18 mutated arm was 7.0 months, exon 20 mutated arm was 4.3 months, and complex mutation positive group was 17.3 months, and this was statistically significant (p = 0.036). The longest OS was 32.5 months, seen in the complex mutations group, which was not statistically different than exon 18 and in exon 20 mutated groups (21.0 and 21.2 months, respectively) (p = 0.323).
Conclusion: In this patient group, especially patients with complex mutations are as sensitive to EGFR TKI treatment similar to classical mutations, and in patients with rare exon 18 and exon 20 EGFR mutation both first- and second-generation EGFR-TKIs should be considered, especially as first- and second-line options.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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