Cargando…
Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors
BACKGROUND: Overall survival (OS) in patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs) is poor. We aimed to identify prognostic factors and ascertain treatment outcomes of first-line afatinib for patients with epidermal growth factor receptor (EGFR)-mutant NSCLC with BM in...
Autores principales: | , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326794/ https://www.ncbi.nlm.nih.gov/pubmed/37425421 http://dx.doi.org/10.21037/tlcr-22-832 |
_version_ | 1785069496837341184 |
---|---|
author | Kim, Jehun Jang, Tae Won Choi, Chang Min Kim, Mi Hyun Lee, Sung Yong Park, Cheol Kyu Chang, Yoon Soo Lee, Kye Young Kim, Seung Joon Yang, Sei Hoon Ryu, Jeong Seon Lee, Jeong Eun Lee, Shin Yup Park, Chan Kwon Lee, Sang Hoon Jang, Seung Hun Yoon, Seong Hoon |
author_facet | Kim, Jehun Jang, Tae Won Choi, Chang Min Kim, Mi Hyun Lee, Sung Yong Park, Cheol Kyu Chang, Yoon Soo Lee, Kye Young Kim, Seung Joon Yang, Sei Hoon Ryu, Jeong Seon Lee, Jeong Eun Lee, Shin Yup Park, Chan Kwon Lee, Sang Hoon Jang, Seung Hun Yoon, Seong Hoon |
author_sort | Kim, Jehun |
collection | PubMed |
description | BACKGROUND: Overall survival (OS) in patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs) is poor. We aimed to identify prognostic factors and ascertain treatment outcomes of first-line afatinib for patients with epidermal growth factor receptor (EGFR)-mutant NSCLC with BM in a real-world setting. METHODS: This retrospective observational study reviewed electronic records of patients with EGFR-mutant NSCLC who received first-line afatinib treatment between October 2014 and October 2019 in 16 hospitals across South Korea. The Kaplan-Meier method estimated time on treatment (TOT) and OS; multivariate analyses were performed using Cox proportional hazards (PH) models. RESULTS: Among 703 patients who received first-line afatinib, 262 (37.3%) had baseline BM. Of 441 patients without baseline BM, 92 (20.9%) developed central nervous system (CNS) failure. Compared with patients without CNS failure, those with CNS failure during afatinib treatment were younger (P=0.012), had a higher Eastern Cooperative Oncology Group (ECOG) performance status (PS) (P<0.001), increased metastatic site involvement (P<0.001), advanced stage disease (P<0.001), with liver metastasis (P=0.008) and/or bone metastasis (P<0.001) at baseline. Cumulative incidence of CNS failure in years 1, 2 and 3 was 10.1%, 21.5% and 30.0%, respectively. In multivariate analysis, cumulative incidence was significantly higher in patients with ECOG PS ≥2 (P<0.001), uncommon EGFR mutations (P=0.001), and no baseline pleural metastasis (P=0.017). Median TOT was 16.0 months (95% CI: 14.8–17.2) and, in patients with CNS failure, without CNS failure, and with baseline BM was 12.2, 18.9, and 14.1 months, respectively (P<0.001). Median OS was 52.9 months (95% CI: 45.4–60.3) and, in patients with CNS failure, without CNS failure, and with baseline BM was 29.1, 67.3 and 48.5 months, respectively (P<0.001). CONCLUSIONS: First-line afatinib in the real-world setting showed clinically meaningful effectiveness in patients with EGFR-mutant NSCLC and BM. CNS failure was a poor prognostic factor for TOT and OS correlating with younger age, poor ECOG PS, higher metastatic number, advanced disease stage, uncommon EGFR mutations, and baseline liver and/or bone metastases. |
format | Online Article Text |
id | pubmed-10326794 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-103267942023-07-08 Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors Kim, Jehun Jang, Tae Won Choi, Chang Min Kim, Mi Hyun Lee, Sung Yong Park, Cheol Kyu Chang, Yoon Soo Lee, Kye Young Kim, Seung Joon Yang, Sei Hoon Ryu, Jeong Seon Lee, Jeong Eun Lee, Shin Yup Park, Chan Kwon Lee, Sang Hoon Jang, Seung Hun Yoon, Seong Hoon Transl Lung Cancer Res Original Article BACKGROUND: Overall survival (OS) in patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs) is poor. We aimed to identify prognostic factors and ascertain treatment outcomes of first-line afatinib for patients with epidermal growth factor receptor (EGFR)-mutant NSCLC with BM in a real-world setting. METHODS: This retrospective observational study reviewed electronic records of patients with EGFR-mutant NSCLC who received first-line afatinib treatment between October 2014 and October 2019 in 16 hospitals across South Korea. The Kaplan-Meier method estimated time on treatment (TOT) and OS; multivariate analyses were performed using Cox proportional hazards (PH) models. RESULTS: Among 703 patients who received first-line afatinib, 262 (37.3%) had baseline BM. Of 441 patients without baseline BM, 92 (20.9%) developed central nervous system (CNS) failure. Compared with patients without CNS failure, those with CNS failure during afatinib treatment were younger (P=0.012), had a higher Eastern Cooperative Oncology Group (ECOG) performance status (PS) (P<0.001), increased metastatic site involvement (P<0.001), advanced stage disease (P<0.001), with liver metastasis (P=0.008) and/or bone metastasis (P<0.001) at baseline. Cumulative incidence of CNS failure in years 1, 2 and 3 was 10.1%, 21.5% and 30.0%, respectively. In multivariate analysis, cumulative incidence was significantly higher in patients with ECOG PS ≥2 (P<0.001), uncommon EGFR mutations (P=0.001), and no baseline pleural metastasis (P=0.017). Median TOT was 16.0 months (95% CI: 14.8–17.2) and, in patients with CNS failure, without CNS failure, and with baseline BM was 12.2, 18.9, and 14.1 months, respectively (P<0.001). Median OS was 52.9 months (95% CI: 45.4–60.3) and, in patients with CNS failure, without CNS failure, and with baseline BM was 29.1, 67.3 and 48.5 months, respectively (P<0.001). CONCLUSIONS: First-line afatinib in the real-world setting showed clinically meaningful effectiveness in patients with EGFR-mutant NSCLC and BM. CNS failure was a poor prognostic factor for TOT and OS correlating with younger age, poor ECOG PS, higher metastatic number, advanced disease stage, uncommon EGFR mutations, and baseline liver and/or bone metastases. AME Publishing Company 2023-06-12 2023-06-30 /pmc/articles/PMC10326794/ /pubmed/37425421 http://dx.doi.org/10.21037/tlcr-22-832 Text en 2023 Translational Lung Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Kim, Jehun Jang, Tae Won Choi, Chang Min Kim, Mi Hyun Lee, Sung Yong Park, Cheol Kyu Chang, Yoon Soo Lee, Kye Young Kim, Seung Joon Yang, Sei Hoon Ryu, Jeong Seon Lee, Jeong Eun Lee, Shin Yup Park, Chan Kwon Lee, Sang Hoon Jang, Seung Hun Yoon, Seong Hoon Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
title | Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
title_full | Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
title_fullStr | Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
title_full_unstemmed | Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
title_short | Real-world analysis of first-line afatinib in patients with EGFR-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
title_sort | real-world analysis of first-line afatinib in patients with egfr-mutant non-small cell lung cancer and brain metastasis: survival and prognostic factors |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326794/ https://www.ncbi.nlm.nih.gov/pubmed/37425421 http://dx.doi.org/10.21037/tlcr-22-832 |
work_keys_str_mv | AT kimjehun realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT jangtaewon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT choichangmin realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT kimmihyun realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT leesungyong realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT parkcheolkyu realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT changyoonsoo realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT leekyeyoung realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT kimseungjoon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT yangseihoon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT ryujeongseon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT leejeongeun realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT leeshinyup realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT parkchankwon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT leesanghoon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT jangseunghun realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors AT yoonseonghoon realworldanalysisoffirstlineafatinibinpatientswithegfrmutantnonsmallcelllungcancerandbrainmetastasissurvivalandprognosticfactors |