Osimertinib vs. afatinib as first-line treatment for patients with metastatic non-small cell lung cancer with an EGFR exon 19 deletion or exon 21 L858R mutation

• Published in: Journal of thoracic disease Vol. 15; no. 11; pp. 6115 - 6125
• Main Authors: Gilardone, Sophia, Thapa, Ram, Laborde, José, Shafique, Michael, Saltos, Andreas, Creelan, Ben, Tanvetyanon, Tawee, Chiappori, Alberto, Simon, George, Haura, Eric B., Gray, Jhanelle E., Chen, Dung-Tsa, Melzer, Daniel, Pellini, Bruna
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 30.11.2023
• Subjects: Original; Epidermal growth factor receptor mutations (EGFR mutations); afatinib; EGFR tyrosine kinase inhibitor (EGFR TKI); non-small cell lung cancer (NSCLC); osimertinib
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd-23-686

The optimal treatment sequencing for patients with metastatic epidermal growth factor receptor ( )-mutant non-small cell lung cancer (NSCLC) remains a subject of debate. In the United States, osimertinib is the preferred tyrosine kinase inhibitor (TKI) in the first-line setting. However, small retrospective studies suggest that alternative TKI sequencing strategies may produce similar outcomes. This study aimed to compare the outcomes of patients with metastatic NSCLC harboring an exon 19 deletion or exon 21 L858R mutation treated with osimertinib afatinib as first-line therapy. This retrospective, single-institution study examined 86 patients with metastatic -mutant NSCLC treated with either afatinib (n=15) or osimertinib (n=71) in the first-line setting. The primary outcome was progression-free survival (PFS), and secondary endpoints included time on TKI, overall survival (OS), and the incidence of adverse events (AEs). There was no difference in the PFS (median: 27.9 29.0 months, P=0.75), OS (P=0.18), and the median time on first-line TKI (23.9 15.2 months, P=0.10) between the afatinib and osimertinib groups, respectively. The number of AEs was also similar between the two treatment groups (P=0.17). In this real-world retrospective study, there were no differences in PFS or OS between patients treated with afatinib or osimertinib in the first-line setting. These findings should be further investigated in larger prospective studies.