PMID- 38090314
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231213
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 15
IP  - 11
DP  - 2023 Nov 30
TI  - Osimertinib vs. afatinib as first-line treatment for patients with metastatic 
      non-small cell lung cancer with an EGFR exon 19 deletion or exon 21 L858R 
      mutation.
PG  - 6115-6125
LID - 10.21037/jtd-23-686 [doi]
AB  - BACKGROUND: The optimal treatment sequencing for patients with metastatic 
      epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) 
      remains a subject of debate. In the United States, osimertinib is the preferred 
      EGFR tyrosine kinase inhibitor (TKI) in the first-line setting. However, small 
      retrospective studies suggest that alternative EGFR TKI sequencing strategies may 
      produce similar outcomes. This study aimed to compare the outcomes of patients 
      with metastatic NSCLC harboring an EGFR exon 19 deletion or exon 21 L858R 
      mutation treated with osimertinib vs. afatinib as first-line therapy. METHODS: 
      This retrospective, single-institution study examined 86 patients with metastatic 
      EGFR-mutant NSCLC treated with either afatinib (n=15) or osimertinib (n=71) in 
      the first-line setting. The primary outcome was progression-free survival (PFS), 
      and secondary endpoints included time on EGFR TKI, overall survival (OS), and the 
      incidence of adverse events (AEs). RESULTS: There was no difference in the PFS 
      (median: 27.9 vs. 29.0 months, P=0.75), OS (P=0.18), and the median time on 
      first-line EGFR TKI (23.9 vs. 15.2 months, P=0.10) between the afatinib and 
      osimertinib groups, respectively. The number of AEs was also similar between the 
      two treatment groups (P=0.17). CONCLUSIONS: In this real-world retrospective 
      study, there were no differences in PFS or OS between patients treated with 
      afatinib or osimertinib in the first-line setting. These findings should be 
      further investigated in larger prospective studies.
CI  - 2023 Journal of Thoracic Disease. All rights reserved.
FAU - Gilardone, Sophia
AU  - Gilardone S
AD  - Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, 
      PA, USA.
FAU - Thapa, Ram
AU  - Thapa R
AD  - Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, 
      Tampa, FL, USA.
FAU - Laborde, Jose
AU  - Laborde J
AD  - Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, 
      Tampa, FL, USA.
FAU - Shafique, Michael
AU  - Shafique M
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Saltos, Andreas
AU  - Saltos A
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Creelan, Ben
AU  - Creelan B
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Tanvetyanon, Tawee
AU  - Tanvetyanon T
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Chiappori, Alberto
AU  - Chiappori A
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Simon, George
AU  - Simon G
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Haura, Eric B
AU  - Haura EB
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Gray, Jhanelle E
AU  - Gray JE
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
FAU - Chen, Dung-Tsa
AU  - Chen DT
AD  - Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, 
      Tampa, FL, USA.
FAU - Melzer, Daniel
AU  - Melzer D
AD  - Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, 
      Tampa, FL, USA.
FAU - Pellini, Bruna
AU  - Pellini B
AD  - Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research 
      Institute, Tampa, FL, USA.
AD  - Department of Oncologic Sciences, Morsani College of Medicine, University of 
      South Florida, Tampa, FL, USA.
LA  - eng
PT  - Journal Article
DEP - 20231108
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC10713299
OTO - NOTNLM
OT  - EGFR tyrosine kinase inhibitor (EGFR TKI)
OT  - Epidermal growth factor receptor mutations (EGFR mutations)
OT  - afatinib
OT  - non-small cell lung cancer (NSCLC)
OT  - osimertinib
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jtd.amegroups.com/article/view/10.21037/jtd-23-686/coif). B.P. has 
      received research support to the institution from Bristol Myers Squibb, speaker 
      honoraria from BioAscend, Merck, MJH Life Science, Play to Know AG, Grupo 
      Pardini, GBOT, Doctaforum, Foundation Medicine, and has done consulting/advisory 
      board work with Guidepoint, Guardant Health, Foundation Medicine, Illumina, BMS, 
      Regeneron, AstraZeneca, and AH Merus. B.P. reports funding to the institution 
      from the Bristol Myers Squibb Foundation/the Robert A. Winn Diversity in Clinical 
      Trials Awards Program. D.M. has done consulting/advisory board work with Dedham 
      Group, Precisionxtract, Pfizer, Eli Lily, and Takeda, and has received speaker 
      honorarium from Jazz Pharmaceuticals. M.S. has done consulting/advisory board 
      work with Jazz Pharmaceuticals and GlaxoSmithKline. M.S. reports funding from 
      Daiichi Sankyo/Lilly and funding to the institution from Merck Serono, Vaccinex, 
      Nektar, Amphivena, and Pfizer. A.S. served as speaker honoraria for MJH Life 
      Science and HMP Global and has done consulting/advisory board work with Daiichi 
      Sankyo, Eli Lilly, and Zymeworks. A.S. reports funding to the institution from 
      Genetech, Genmab, Turning Point Therapeutics, Novartis, Eli Lily, Memgen, 
      Mersana, BioAlta, AstraZeneca, Daiichi Sankyo. B.C. has received speaking fees 
      from AstraZeneca, ARIAD Pharmaceuticals and Hoffmann-La Roche and consultant fees 
      from Xilio, Achilles, ER Squibb, Hoffmann-La Roche, AstraZeneca, AbbVie, KSQ 
      Therapeutics, GlaxoSmithKline, Gilead Sciences, Celgene. B.C. has received 
      speaking fees from AstraZeneca plc, ARIAD Pharmaceuticals, Hoffmann-La Roche Ag, 
      and OMNI Health Media LLC, and consultant fees from AbbVie, Achilles Therapeutics 
      plc, AstraZeneca plc, Celgene, ER Squibb, G1 Therapeutics Inc, Gilead Sciences, 
      GlaxoSmithKline, Hoffmann-La Roche, KSQ Therapeutics, MJH Life Sciences, 
      Regeneron Pharmaceuticals Inc., Techspert IO Ltd., and Xilio and has received 
      research funding from ER Squibb LLC and Iovance Biotherapeutics Inc., and has a 
      patent applications filed US201962865697P and US202062976867P outside the 
      submitted work. A.C. has received speaker bureau funding from Genentech, Merck, 
      Takeda, Novartis, Boehringer Ingelheim, and Celgene and research funding from 
      Novartis and Bristol-Myers Squibb. E.B.H. received speaker honoraria for ASCO 
      2022 Annual Meeting and the 35th Aspen Cancer Conference, received consulting 
      fees from Ellipses, Kanaph Therapeutics, Inc., and ORI Capital II, Inc. E.B.H. 
      has done data safety monitoring/advisory board work with Amgen, Jassen, RevMed, 
      and reports grants to the institution from Revolution Medicine. J.E.G. has 
      received research support AstraZeneca, Boehringer Ingelheim, Bristol Myers 
      Squibb, Genetech, GI Therapeutics, Ludwig Institute of Cancer Research, Merck, 
      Novartis, Pfizer. J.E.G. has done consulting/advisory board work with AbbVie, 
      AstraZeneca, Axiom HC Strategies, Blueprint Medicines, Bristol Myers Squibb, 
      Celgene Corp, Daiichi Sankyo, EMD Serono-Merck KGaA, Genentech, Inivata, Janssen 
      Scientific Affairs, Jazz Pharmaceuticals, Loxo Oncology Inc, Merck, Novartis, 
      OncoCyte Biotechnology Company, Sanofi Pharmaceuticals, Takeda Pharmaceuticals, 
      Triptych Health Partners. G.S. reports funding from AstraZeneca, NovoCure, and 
      Syneos Health, consulting fees and speaker honoraria from AstraZeneca, NovoCure, 
      OncLive, and DAVA Oncology. G.S. has done data safety monitoring/advisory board 
      work with AstraZeneca, NovoCure, and FLASCO. The other authors have no conflicts 
      of interest to declare.
EDAT- 2023/12/13 18:42
MHDA- 2023/12/13 18:43
PMCR- 2023/11/30
CRDT- 2023/12/13 13:07
PHST- 2023/04/25 00:00 [received]
PHST- 2023/09/21 00:00 [accepted]
PHST- 2023/12/13 18:43 [medline]
PHST- 2023/12/13 18:42 [pubmed]
PHST- 2023/12/13 13:07 [entrez]
PHST- 2023/11/30 00:00 [pmc-release]
AID - jtd-15-11-6115 [pii]
AID - 10.21037/jtd-23-686 [doi]
PST - ppublish
SO  - J Thorac Dis. 2023 Nov 30;15(11):6115-6125. doi: 10.21037/jtd-23-686. Epub 2023 
      Nov 8.