Efficacy and Safety of Afatinib for EGFR-mutant Non-small Cell Lung Cancer, Compared with Gefitinib or Erlotinib.
Efficacy and Safety of Afatinib for EGFR-mutant Non-small Cell Lung Cancer, Compared with Gefitinib or Erlotinib.
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与吉非替尼或厄洛替尼相比，Afatinib对EGFR突变非小细胞肺癌的功效和安全性。
DOI：
10.4143/crt.2018.117
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发表时间：
2019-04
影响因子：
4.6
通讯作者：
Sun JM
中科院分区：
文献类型：
--
作者：
Kim Y;Lee SH;Ahn JS;Ahn MJ;Park K;Sun JM
我们试图评价与吉非替尼或厄洛替尼相比，阿法替尼一线治疗表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）患者的治疗结局是否存在任何特定特征。我们分析了2014年至2016年期间在三星医疗中心接受一线阿法替尼、吉非替尼或厄洛替尼治疗晚期EGFR突变型NSCLC的患者。总计467例患者接受一线阿法替尼（n=165）、吉非替尼（n=230）或厄洛替尼（n=72）治疗。阿法替尼更常用于携带外显子19（Del 19）缺失的肿瘤患者，而吉非替尼组中老年人、女性和从不吸烟者更多。阿法替尼、吉非替尼和厄洛替尼的中位无进展生存期（PFS）分别为19.1个月、13.7个月和14.0个月（p=0.001）。在Del 19或罕见EGFR突变亚组中，阿法替尼的上级PFS更显著。三种药物的总体毒性特征相当，但阿法替尼（7.3%）中检测到的3级或4级毒性多于吉非替尼（2.6%）或厄洛替尼（1.8%）。阿法替尼的常见3级或4级毒性包括腹泻（3.0%）、甲沟炎（2.4%）和皮疹（1.8%）。与吉非替尼（5/230，2%）和厄洛替尼（4/72，6%）相比，阿法替尼（112/165，68%）治疗患者更常需要剂量调整。然而，有趣的是，阿法替尼组的剂量降低并未损害其PFS疗效（剂量降低组vs.未降低组，23. 5个月vs. 12. 4个月）。一线阿法替尼显示出令人满意的疗效数据和可管理的毒性特征。
We tried to evaluate whether there are any specific features in treatment outcomes of firstline afatinib in patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC), compared with gefitinib or erlotinib. We analyzed patients treated with first-line afatinib, gefitinib, or erlotinib for advanced EGFR-mutant NSCLC at Samsung Medical Center between 2014 and 2016. In total, 467 patients received first-line afatinib (n=165), gefitinib (n=230), or erlotinib (n=72). Afatinib was used more often in patients with tumors harboring deletion in exon 19 (Del19), whereas the gefitinib group had more elderly, females, and never smokers. The median progression-free survival (PFS) time for afatinib, gefitinib, and erlotinib was 19.1 months, 13.7 months, and 14.0 months, respectively (p=0.001). The superior PFS of afatinib was more remarkable in subgroups of Del19 or uncommon EGFR mutations. Overall toxicity profiles of the three drugs were comparable, though more grade 3 or 4 toxicities were detected in afatinib (7.3%) compared with gefitinib (2.6%) or erlotinib (1.8%). The common grade 3 or 4 toxicities of afatinib included diarrhea (3.0%), paronychia (2.4%), and skin rash (1.8%). Dose modification was more frequently required in patients treated with afatinib (112/165, 68%), compared with gefitinib (5/230, 2%) and erlotinib (4/72, 6%). Interestingly, however, dose reduction in the afatinib group did not impair its efficacy in terms of PFS (dose reduction vs. no reduction group, 23.5 months vs. 12.4 months). First-line afatinib showed satisfactory efficacy data and manageable toxicity profiles.
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