Lower starting dose of afatinib for the treatment of metastatic lung adenocarcinoma harboring exon 21 and exon 19 mutations

BMC Cancer

Ming-Shyan Huang¹  Huang-Chi Chen²  Mei-Chiou Shen³  Yi-Chieh Chen⁴  Mei-Hsuan Lee⁵  Chia-Yu Kuo⁶  Jen-Yu Hung⁷  Inn-Wen Chong⁸  Ming-Ju Tsai⁹  Ying-Ming Tsai⁹  Chih-Jen Yang^1,10 

[1]Department of Internal Medicine, E-DA Cancer Hospital, Kaohsiung, Taiwan

[2]Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[3]Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[4]Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[5]Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[6]Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[7]Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[8]Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[9]Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[10]Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[11]Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[12]Respiratory therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[13]Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[14]Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[15]Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[16]Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[17]Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

[18]Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[19]Respiratory therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[20]Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou First Road, Kaohsiung City, Taiwan

关键词: Epidermal growth factor receptor tyrosine kinase inhibitor;    Afatinib;    Lower starting dose;    Adverse drug reaction;   

DOI  :  10.1186/s12885-021-08235-3

来源: Springer

【 摘 要 】

BackgroundAfatinib has shown favorable response rates (RRs) and longer progression free survival (PFS) in lung cancer patients harboring EGFR mutations compared with standard platinum-based chemotherapy. However, serious adverse drug reactions (ADRs) limit the clinical application of afatinib.MethodsWe designed a retrospective study, enrolling all patients with metastatic lung adenocarcinoma who were diagnosed and treated with 30 or 40 mg daily afatinib as their initial treatment in three Kaohsiung Medical University-affiliated hospitals in Taiwan.ResultsA total of 179 patients were enrolled in the study, of which 102 (57%) and 77 (43%) received 30 mg and 40 mg afatinib daily as their initial treatment, respectively. The patients initially using 30 mg afatinib daily had a similar RR (75% vs. 83%, p = 0.1672), median PFS (14.5 vs. 14.8 months, log-rank p = 0.4649), and median OS (34.0 vs. 25.2 months, log-rank p = 0.5982) compared with those initially using 40 mg afatinib daily. Patients initially receiving 30 mg afatinib daily had fewer ADRs compared with those using 40 mg daily. The overall incidence of moderate and severe ADRs was significantly lower in patients receiving 30 mg afatinib daily compared with those using 40 mg daily (49% vs. 77%, p = 0.002); similar findings was observed in terms of severe ADRs (7% vs. 24%, p < 0.0001).ConclusionPatients receiving 30 mg afatinib daily as their initial treatment had similar RR, PFS, OS, but significantly fewer serious ADRs, as compared with those using 40 mg as their starting dose.

【 授权许可】

CC BY