Preventing and treating brain metastases with three first-line EGFR-tyrosine kinase inhibitors in patients with EGFR mutation-positive advanced non-small cell lung cancer

Su, Po-Lan; Wu, Yi-Lin; Chang, Wei-Yuan; Ho, Chung-Liang; Tseng, Yau-Lin; Lai, Wu-Wei; Su, Wu-Chou; Lin, Chien-Chung; Yang, Szu-Chun

doi:10.1177/1758835918797589

Cited by 49Lung Cancer Treatments and MutationsBrain Metastases and TreatmentLung Cancer Diagnosis and Treatment

Preventing and treating brain metastases with three first-line EGFR-tyrosine kinase inhibitors in patients with EGFR mutation-positive advanced non-small cell lung cancer

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Su, Po-Lan, Wu, Yi-Lin, Chang, Wei-Yuan, Ho, Chung-Liang, Tseng, Yau-Lin, Lai, Wu-Wei, Su, Wu-Chou, Lin, Chien-Chung +1 more·2018·Therapeutic Advances in Medical Oncology

DOI 10.1177/1758835918797589PMC PMC6156208

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Abstract

Introduction: Brain metastases (BM) are common in advanced non-small cell lung cancer (NSCLC), and the prognosis is poor with few therapeutic options. This study evaluated the efficacy of three epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) in preventing and treating BM in patients with EGFR mutation-positive advanced NSCLC. Methods: Patients with EGFR mutation-positive advanced NSCLC who visited a tertiary referral center from 1 December 2013 to 30 November 2017 were analyzed retrospectively. They received gefitinib, erlotinib, or afatinib until disease progression, death, or intolerable adverse events. The cumulative incidence of subsequent BM of initial non-BM patients, progression-free survival (PFS), and overall survival (OS) of the BM and non-BM patients were estimated and compared using the Kaplan–Meier and log-rank tests. Results: 306 NSCLC patients were enrolled, with 116, 75, and 115 receiving first-line gefitinib, erlotinib, and afatinib, respectively. The afatinib group had a better PFS [12.7 versus 9.8 months; hazard ratio (HR) 0.59, p = 0.001] and OS (39.1 versus 22.0 months; HR 0.64, p = 0.035) than the gefitinib group. Afatinib tended to provide better BM prevention than gefitinib (BM cumulative incidence, HR 0.49; 95% confidence interval 0.34–0.71, p < 0.001) according to a Cox model adjusted for possible confounders. Patients with initial BM had a shorter PFS ( p < 0.001) and OS ( p = 0.015) than those without initial BM. Among the former, there were no differences in median PFS ( p = 0.34) and median OS ( p = 0.46) in the three EGFR-TKI groups. Conclusions: Our data suggested that, compared with gefitinib, afatinib provided better benefits significantly in terms of PFS and OS. Both had the same effectiveness in preventing subsequent BM.

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In that real-world study, among patients without baseline brain metastases, after adjusting for confounders, those in the afatinib group had a significantly lower HR for development of subsequent brain metastases than those in the gefitinib group.
“Another subgroup analysis, involving patients without baseline brain metastases, found that after adjusting for possible confounding factors, those in the afatinib group had a significantly lower HR for the development of subsequent brain metastases than did those in the gefitinib group.”
From Afatinib for the treatment of EGFR mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [80]
In that real-world study, PFS and OS were similar across the three EGFR TKIs in a subgroup analysis comparing patients with ECOG performance status 0-1 and Del19 mutations.
“PFS and OS were similar across the three EGFR TKIs in a subgroup analysis comparing patients with an ECOG performance status of 0–1 and Del19 mutations.”
From Afatinib for the treatment of EGFR mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [80]
In that real-world study, the three treatments showed similar efficacy in patients with baseline brain metastases.
“However, the three treatments showed similar efficacy in patients with baseline brain metastases.”
From Afatinib for the treatment of EGFR mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [80]

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Authors: Su, P.-L., Wu, Y.-L., Chang, W.-Y., Ho, C.-L., Tseng, Y.-L., Lai, W.-W., Su, W.-C., Lin, C.-C., & Yang, S.-C.
Affiliations: National Cheng Kung University Hospital (TW)
Corresponding author: Lin, Chien-Chung
ORCID: Su, Po-Lan
Wu, Yi-Lin
Tseng, Yau-Lin
Lai, Wu-Wei
Su, Wu-Chou
Lin, Chien-Chung
Yang, Szu-Chun
Venue: Therapeutic Advances in Medical Oncology
Publisher: SAGE Publications
Published: 2018-01
Volume: 10
Pages: 1758835918797589-1758835918797589
ISSN: 1758-8340 (ISSN-L)
1758-8359
DOI: 10.1177/1758835918797589
PMC: PMC6156208
OpenAlex: W2893850807
Cited by: 49
References: 37
Citations by year: 2025: 1 · 2024: 3 · 2023: 13 · 2022: 6 · 2021: 16 · 2020: 3 · 2019: 7
FWCI: 4.90
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Therapeutic Advances in Medical Oncology (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Ministry of Science and Technology, Taiwan (MOST 104-2314-B-006-046-MY3, MOST105-2314-B-076- MY2)
Ministry of Health and Welfare (MOHW106-TDU-B-211-144-004)
National Cheng Kung University Hospital (NCKUH-10503002)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Brain Metastases and Treatment
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords: brain metastases, EGFR tyrosine kinase inhibitors, EGFR-mutant non-small cell lung cancer, gefitinib, erlotinib, afatinib, first-line therapy, brain metastasis prevention, progression-free survival, overall survival

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Preventing and treating brain metastases with three first-line EGFR-tyrosine kinase inhibitors in patients with EGFR mutation-positive advanced non-small cell lung cancer

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