A multicenter cohort study of osimertinib compared with afatinib as first-line treatment for EGFR-mutated non-small-cell lung cancer from practical dataset: CJLSG1903

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K. Ito¹  M. Morise³  K. Wakuda⁴  O. Hataji¹  T. Shimokawaji⁵  K. Takahashi⁶  N. Furuya⁷  Y. Takeyama⁸  Y. Goto⁹  T. Abe^1,10  T. Kato^1,11  S. Ozone³  S. Ikeda^1,12  Y. Kogure^1,13  T. Yokoyama^1,14  M. Kimura^1,15  H. Yoshioka^1,16  K. Murotani^1,17  M. Kondo⁹  H. Saka^1,18 

[1] Respiratory Center, Matsusaka Municipal Hospital;Department of Biostatistics, Yokohama City University School of Medicine;Department of Respiratory Medicine, Nagoya University Graduate School of Medicine;Division of Thoracic Oncology, Shizuoka Cancer Center;Department of Internal Medicine, Niigata Cancer Center Hospital;Department of Respiratory Medicine, Anjo Kosei Hospital;Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine;Department of Respiratory Medicine, Toyohashi Municipal Hospital;Department of Respiratory Medicine, Fujita Health University School of Medicine;Department of Respiratory Medicine, Ogaki Municipal Hospital;Division of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine;Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center;Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center;Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital;Department of Respiratory Medicine, Toyota Memorial Hospital;Department of Thoracic Oncology, Kansai Medical University Hospital;Biostatistics Center, Kurume University;Department of Respiratory Medicine, Matsunami General Hospital

关键词: non-small-cell lung cancer;    EGFR mutation;    osimertinib;    afatinib;    real world data;   

DOI  :  10.1016/j.esmoop.2021.100115

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background FLAURA, the prospective trial of osimertinib as a first-line therapy compared with first-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), did not show superior survival benefit for osimertinib in either the subgroup of Asians or the subgroup with the L858R mutation. In addition, the superiority of osimertinib compared with second-generation EGFR-TKI is thus far unclear.Patients and methods We reviewed the clinical data of all consecutive patients who were treated with osimertinib or afatinib as first-line therapy between May 2016 and October 2019 from 15 institutions in Japan. We defined the groups based on first-line EGFR-TKI as the afatinib group and the osimertinib group. Outcomes included time to discontinuation of any EGFR-TKI (TD-TKI), overall survival (OS), and time to treatment failure, with propensity score analysis carried out as an exploratory analysis in the survival and subgroup analyses.Results A total of 554 patients were enrolled. Data on 326 patients in the osimertinib group, and 224 patients in the afatinib group were analyzed. TD-TKI adjusted by propensity score in the afatinib and osimertinib groups was 18.6 months (95% confidence interval 15.8 to 22.0) and 20.5 months (95% confidence interval 13.8 to not reached), respectively, without significant difference (P = 0.204). OS adjusted by propensity score favored the afatinib group with a significant difference (P = 0.018). Subgroup analysis with propensity score showed that patients with L858R and without brain metastasis had superior survival benefit with afatinib compared with osimertinib (P < 0.001).Conclusions TD-TKI in the afatinib group was not significantly prolonged compared with the osimertinib group in the practical data. In the exploratory analysis of patients with L858R-mutated non-small-cell lung cancer without brain metastasis, afatinib showed more benefit in OS over osimertinib.

【 授权许可】

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