Jeremy J W Chen1, Gee-Chen Chang2,3,4, Yen-Hsiang Huang5,6,7, Kuo-Hsuan Hsu8, Jeng-Sen Tseng5,6,7, Tsung-Ying Yang5, Kun-Chieh Chen9,10,11, Kang-Yi Su12,13, Sung-Liang Yu12,13,14,15,16,17. 1. Institute of Biomedical Sciences, National Chung Hsing University, No. 145, Xingda Rd., South Dist., Taichung, 402, Taiwan. jwchen@dragon.nchu.edu.tw. 2. Institute of Biomedical Sciences, National Chung Hsing University, No. 145, Xingda Rd., South Dist., Taichung, 402, Taiwan. geechen@gmail.com. 3. Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Road, Taichung, 402, Taiwan. geechen@gmail.com. 4. School of Medicine and Institute of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Road, Taichung, 402, Taiwan. geechen@gmail.com. 5. Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan. 6. Institute of Biomedical Sciences, National Chung Hsing University, No. 145, Xingda Rd., South Dist., Taichung, 402, Taiwan. 7. Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sect. 2, Linong St., Taipei, 112, Taiwan. 8. Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan. 9. Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Road, Taichung, 402, Taiwan. 10. School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Road, Taichung, 402, Taiwan. 11. Department of Applied Chemistry, National Chi Nan University, No. 1, University Road., Puli Township, Nantou, 545, Taiwan. 12. Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, No. 1, Sect. 1, Jen Ai Road, Taipei, 100, Taiwan. 13. Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Zhung-Shan South Road, Taipei, 100, Taiwan. 14. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No. 1, Sect. 1, Jen Ai Road, Taipei, 100, Taiwan. 15. Center of Genomic and Precision Medicine, National Taiwan University, No. 2, Syu-jhou Road, Taipei, 100, Taiwan. 16. Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, No. 1, Sect. 1, Jen Ai Road, Taipei, 100, Taiwan. 17. Graduate Institute of Pathology, College of Medicine, National Taiwan University, No. 1, Sect. 1, Jen Ai Road, Taipei, 100, Taiwan.
Abstract
BACKGROUND: Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors are the standard first-line treatment for patients with advanced and recurrent EGFR-positive non-small cell lung cancer. OBJECTIVE: The main objective of the present study was to compare the clinical efficacies between osimertinib and afatinib as first-line treatment in patients with EGFR-mutant non-small cell lung cancer. METHODS: We retrospectively analyzed patients with advanced and recurrent non-small cell lung cancer who harbored an exon 19 deletion or an exon 21 L858R mutation and were being given either osimertinib or afatinib as first-line treatment from January 2018 to December 2020. RESULTS: A total of 128 patients were selected for this study. The osimertinib group included 47 patients, while 81 patients received afatinib. The median follow-up time was 20.1 months in the osimertinib group and 22.7 months in the afatinib group. The median progression-free survival was 18.8 months and 13.1 months in the osimertinib and afatinib groups, respectively (hazard ratio 0.75 [95% confidence interval 0.48-1.18]). The median overall survival was not reached in the osimertinib group and was 41.7 months in the afatinib group (hazard ratio 0.79 [95% confidence interval 0.36-1.72]). In patients without brain metastasis, the median progression-free survival was 17.9 months and 17.2 months in the osimertinib and afatinib groups, respectively (hazard ratio 1.02 [95% confidence interval 0.56-1.85]). In patients with brain metastasis at baseline, the median progression-free survival was 22.1 months in the osimertinib group, and 10.9 months in the afatinib group (adjusted hazard ratio 0.45 [95% confidence interval 0.21-0.96]). CONCLUSIONS: Our research demonstrates that there was no strong evidence showing that patients taking osimertinib as first-line treatment experienced longer median progression-free survival and overall survival than patients treated with afatinib. However, there was a statistical significance revealing that osimertinib provided better median progression-free survival than afatinib in patients with brain metastasis at baseline.
BACKGROUND: Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors are the standard first-line treatment for patients with advanced and recurrent EGFR-positive non-small cell lung cancer. OBJECTIVE: The main objective of the present study was to compare the clinical efficacies between osimertinib and afatinib as first-line treatment in patients with EGFR-mutant non-small cell lung cancer. METHODS: We retrospectively analyzed patients with advanced and recurrent non-small cell lung cancer who harbored an exon 19 deletion or an exon 21 L858R mutation and were being given either osimertinib or afatinib as first-line treatment from January 2018 to December 2020. RESULTS: A total of 128 patients were selected for this study. The osimertinib group included 47 patients, while 81 patients received afatinib. The median follow-up time was 20.1 months in the osimertinib group and 22.7 months in the afatinib group. The median progression-free survival was 18.8 months and 13.1 months in the osimertinib and afatinib groups, respectively (hazard ratio 0.75 [95% confidence interval 0.48-1.18]). The median overall survival was not reached in the osimertinib group and was 41.7 months in the afatinib group (hazard ratio 0.79 [95% confidence interval 0.36-1.72]). In patients without brain metastasis, the median progression-free survival was 17.9 months and 17.2 months in the osimertinib and afatinib groups, respectively (hazard ratio 1.02 [95% confidence interval 0.56-1.85]). In patients with brain metastasis at baseline, the median progression-free survival was 22.1 months in the osimertinib group, and 10.9 months in the afatinib group (adjusted hazard ratio 0.45 [95% confidence interval 0.21-0.96]). CONCLUSIONS: Our research demonstrates that there was no strong evidence showing that patients taking osimertinib as first-line treatment experienced longer median progression-free survival and overall survival than patients treated with afatinib. However, there was a statistical significance revealing that osimertinib provided better median progression-free survival than afatinib in patients with brain metastasis at baseline.