First – line Afatinib treatment outcomes in stage IV non – small cell lung cancer harboring uncommon EGFR mutations at Vietnam National Cancer Hospital
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Abstract
Afatinib, a second-generation tyrosine kinase inhibitor, has demonstrated efficacy in patients with non-small cell lung cancer (NSCLC) harboring uncommon EGFR mutations; however, real-world data from Vietnam remain limited. This retrospective study included 88 patients with stage IV lung adenocarcinoma harboring uncommon EGFR mutations treated at Vietnam National Cancer Hospital. The objective response rate (ORR) and disease control rate (DCR) were 62.5% and 83%, respectively. With a median follow-up of 28.8 ± 1.4 months, the median progression-free survival (mPFS) was 11.4 ± 1.1 months. In patients with brain metastases, the mPFS was 11 ± 1.1 months compared with 14.1 ± 5.0 months in those without brain metastases (p = 0.08). Common adverse events included diarrhea, skin toxicity, paronychia, and mucositis, mostly of mild to moderate severity; 12.5% of patients experienced grade 3 toxicities, and no grade 4 toxicities were observed. Afatinib demonstrated favorable efficacy and an acceptable safety profile in Vietnamese patients with stage IV NSCLC harboring uncommon EGFR mutations.
Article Details
Keywords
Afatinib, non - small cell lung cancer, uncommon EGFR mutation
References
2. Ngô Quý Châu. Ung thư phổi. 2008(28): 288. Nhà xuất bản Y học.
3. Sun M, Guo Y, Shao G, et al. Analysis of real-word mutations of lung cancer driver genes in five regions of China. Translational Cancer Research. 2019; 8(7): 2581.
4. Shi Y, Au JS-K, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER). Journal of thoracic oncology. 2014; 9(2): 154-162.
5. Yang JC, Sequist LV, Geater SL, et al. Clinical activity of afatinib in patients with advanced non-small-cell lung cancer harbouring uncommon EGFR mutations: a combined post-hoc analysis of LUX-Lung 2, LUX-Lung 3, and LUX-Lung 6. Lancet Oncol. Jul 2015; 16(7): 830-8. doi:10.1016/S1470-2045(15)00026-1.
6. Dungo RT, Keating GM. Afatinib: first global approval. Drugs. 2013; 73: 1503-1515.
7. Hirsch FR, Varella-Garcia M, Bunn Jr PA, et al. Epidermal growth factor receptor in non-small-cell lung carcinomas: correlation between gene copy number and protein expression and impact on prognosis. Journal of clinical oncology. 2003; 21(20): 3798-3807.
8. Vũ Hà Thanh, Nguyễn Thị Thái Hoà. Kết quả điều trị Afatinib bước 1 trên ung thư phổi không tế bào nhỏ, giai đoạn tiến xa, loại biểu mô tuyến, có đột biến hiếm gặp của gen EGFR tại bệnh viện K. Tạp chí Y học lâm sàng Bệnh viện Trung ương Huế. 2022; (80): 81-89.
9. Luan Van Pham, Anh Tuan Le, Phuong Cam Pham, et al. 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. Therapeutic Advances in Medical Oncology. 2024; 16:17588359241242972.
10. European Medicines Agency. Giotrif: EPAR-product information. Published 2013. Accessed March 20.
11. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). European journal of cancer. 2009; 45(2): 228-247.
12. Rangachari D, Yamaguchi N, VanderLaan PA, et al. Brain metastases in patients with EGFR-mutated or ALK-rearranged non-small-cell lung cancers. Lung cancer. 2015; 88(1): 108-111.
13. Schuette W. Treatment of brain metastases from lung cancer: chemotherapy. Lung cancer. 2004; 45: S253-S257.
14. Robichaux JP, Le X, Vijayan R, et al. Structure-based classification predicts drug response in EGFR-mutant NSCLC. Nature. 2021; 597(7878): 732-737.
15. Hsu P-C, Lee S-H, Chiu L-C, et al. Afatinib in Untreated Stage IIIB/IV Lung Adenocarcinoma with Major Uncommon Epidermal Growth Factor Receptor (EGFR) Mutations (G719X/L861Q/S768I): A Multicenter Observational Study in Taiwan: P.-C. Hsu et al. Targeted oncology. 2023; 18(2): 195-207.
16. Shen Y-C, Tseng G-C, Tu C-Y, et al. Comparing the effects of afatinib with gefitinib or Erlotinib in patients with advanced-stage lung adenocarcinoma harboring non-classical epidermal growth factor receptor mutations. Lung Cancer. 2017;110:56-62.
17. Yang JC-H, Schuler M, Popat S, et al. Afatinib for the treatment of NSCLC harboring uncommon EGFR mutations: a database of 693 cases. Journal of Thoracic Oncology. 2020; 15(5): 803-815.
18. Thai Van Pham, Thanh Ha Vu, Hoa Thai Thi Nguyen., et al. The Effectiveness of Afatinib as First-Line Treatment in Vietnamese Patients With EGFR-Mutant Non-Small Cell Lung Cancer and Brain Metastases. Asia-Pacific Journal of Clinical Oncology. 2025; 21(3): 281-289.
19. Kang L, Mai J, Liang W, et al. CNS efficacy of afatinib as first-line treatment in advanced non-small cell lung cancer patients with EGFR mutations. Frontiers in Oncology. 2023; 13: 1094195.