Afatinib as First-Line Treatment in Asian Patients with EGFR Mutation-Positive NSCLC: A Narrative Review of Real-World Evidence
Journal
Advances in Therapy
Date Issued
2021
Author(s)
Abstract
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) are a standard of care in the first-line treatment of patients with EGFR mutation-positive metastatic non-small-cell lung cancer (NSCLC). EGFR mutations are relatively common in Asian patients with NSCLC, and there is an increasing number of studies supporting the effectiveness of the second-generation TKI afatinib in routine clinical practice in Asia. This article reviews these real-world studies investigating afatinib as first-line treatment for EGFR mutation-positive NSCLC in Asian patients. Evidence from real-world studies with afatinib in this patient population supports findings from randomized controlled trials (RCTs) showing that afatinib is associated with more favorable outcomes compared with the first-generation EGFR TKIs. The effectiveness of afatinib has also been shown in real-world studies in Asian patients with poor prognostic factors, who are often under-represented or excluded from RCTs, such as those with uncommon EGFR mutations, brain metastases, or poor performance status, and elderly patients. The tolerability profile of afatinib in the real-world setting reflects that seen in RCTs, with no new safety signals reported in real-world studies in Asian patients with EGFR mutation-positive NSCLC. Dose-modification strategies also seem to be effective in the real world, with results of the RealGido study, which included 44% Asian patients, confirming findings from prospective clinical trials showing that tolerability-guided afatinib dose modifications can reduce the incidence of adverse events without adversely affecting clinical outcomes. While further research, including clinical trial data, is needed, real-world data have also demonstrated the feasibility of sequential afatinib followed by the third-generation TKI osimertinib in T790M-positive EGFR mutation-positive patients, which showed longer overall survival. Together, these real-world results demonstrate the real-world clinical effectiveness of afatinib as first-line treatment for patients with EGFR mutation-positive NSCLC. ? 2021, The Author(s).
Subjects
Afatinib; Asian patients; Epidermal growth factor receptor; Non-small-cell lung cancer; Real-world evidence; Tyrosine kinase inhibitor
Other Subjects
afatinib; epidermal growth factor receptor; erlotinib; gefitinib; osimertinib; afatinib; EGFR protein, human; epidermal growth factor receptor; protein kinase inhibitor; acne; brain metastasis; cancer chemotherapy; cancer incidence; clinical effectiveness; clinical practice; diarrhea; drug efficacy; drug tolerability; dry skin; gene mutation; human; non small cell lung cancer; paronychia; pharmacology; prevalence; prospective study; pruritus; rash; Review; stomatitis; aged; Asia; genetics; lung tumor; mutation; Afatinib; Aged; Asia; Carcinoma, Non-Small-Cell Lung; ErbB Receptors; Humans; Lung Neoplasms; Mutation; Protein Kinase Inhibitors
Publisher
Adis
Type
review