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Totality outcome of afatinib sequential treatment in patients with EGFR mutation-positive non-small cell lung cancer in South Korea (TOAST): Korean Cancer Study Group (KCSG) LU-19-22

 Hyun Ae Jung  ;  Min Hee Hong  ;  Hyun Woo Lee  ;  Kyung Hee Lee  ;  Il Hwan Kim  ;  Young Joo Min  ;  Hee Kyung Ahn  ;  Byoung Yong Shim  ;  Yoon Hee Choi  ;  Yun-Gyoo Lee  ;  Jeong A Kim  ;  Joung Soon Jang  ;  Seong-Hoon Shin  ;  Keon Uk Park  ;  Jin Hyoung Kang  ;  Keunchil Park 
 TRANSLATIONAL LUNG CANCER RESEARCH, Vol.11(7) : 1369-1379, 2022-07 
Journal Title
Issue Date
Non-small cell lung cancer (NSCLC) ; afatinib ; epidermal growth factor receptor (EGFR) ; sequential treatment ; tyrosine kinase inhibitor (TKI)
Background: Irrespective of the first-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor chosen, acquired resistance to therapy is inevitable. Therefore, a key consideration when assessing therapeutic choices is the availability of subsequent treatment options following disease progression. We assessed clinical outcomes in patients who received first-line afatinib treatment with various second-line treatments including osimertinib for patients acquiring the T790M mutation.

Methods: A total of 737 EGFR mutation-positive (EGFR M+) non-small cell lung cancer (NSCLC) patients receiving first-line afatinib treatment were categorized by second-line treatment: T790M+ sequentially treated with osimertinib (cohort A, n=116); T790M- given chemotherapy or others (cohort B, n=143); patients with unknown T790M status (cohort C, n=111); and patients who were undergoing afatinib treatment at the time of data collection, were dead, had discontinued afatinib treatment due to serious adverse events or were lost to follow-up (cohort D, n=367). The primary outcomes were total time on treatment (TOT) and TOT for first-line (TOT-1) and second-line treatments (TOT-2). Secondary outcomes were objective response rates (ORR), overall survival (OS), and central nervous system (CNS) efficacy.

Results: Median total TOT in cohorts A, B, C, and D were 35.10 months [95% confidence interval (CI): 30.09-43.53 months], 18.80 months (95% CI: 16.92-20.20 months), 12.00 months (95% CI: 10.22-14.98 months), and 42.60 months (95% CI: 30.95-59.23 months), respectively. The ORR of patients given afatinib was 75.7%. In patients with initial brain metastasis without local treatment, the CNS response rate was 67.0% and CNS progression-free survival was 24.70 months (95% CI: 19.84-33.15 months).

Conclusions: This study showed that sequential approach of afatinib followed by second line treatment is an effective therapeutic strategy for EGFR M+ NSCLC patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Hong, Min Hee(홍민희) ORCID logo https://orcid.org/0000-0003-3490-2195
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