Non-Small Cell Lung Cancer Coverage from Every Angle

Comparing TKIs as First-Line Treatment in Japanese Patients With NSCLC

By: Jenna Carter, PhD
Posted: Tuesday, July 6, 2021

A recent article published in ESMO Open Cancer Horizons presented findings based on large-scale practical data of 550 patients with EGFR-mutated non–small cell lung) cancer (NSCLC) treated in the first line with the EGFR tyrosine kinase inhibitors (EGFR-TKI) osimertinib versus afatinib. According to Hideo Saka, MD, PhD, of Matsunami General Hospital, Kasamatsu, Gifu, Japan, and colleagues, the superiority of osimertinib over afatinib could not be demonstrated in all populations, although osimertinib showed effectiveness in patients with brain metastasis and afatinib showed potential benefit in patients with L858R mutation and no brain metastasis.

“Asians account for the majority of EGFR-mutated NSCLC patients in terms of prevalence, with ∼40% of Asians having adenocarcinoma versus ∼20% in the non-Asian population. This confirms that reproducibility of clinical benefit in the Asian population with [this disease] is crucial in this tumor subtype,” stated Dr. Saka and colleagues.

Clinical data were collected from a total of 554 patients from 15 institutions across Japan. They were arranged into two groups based on the TKI they were administered during treatment: the third-generation osimertinib (n = 326) and the second-generation afatinib (n = 224). The study's primary endpoint was the time to discontinuation of TKI treatment, and the secondary endpoint was overall survival.

Findings revealed that the time to discontinuation of treatment adjusted by propensity score in the afatinib and osimertinib groups was 18.6 months (95% confidence interval [CI] = 15.8–22.0 months) and 20.5 months (95% CI = 13.8 months to not reached), respectively (P = .204). Additionally, overall survival adjusted by propensity score was found to be better with afatinib (P = .018). Based on the exploratory analysis of patients with L858R-mutated NSCLC without brain metastasis, afatinib was found to yield more of a benefit in terms of overall survival than osimertinib.

Disclosure: For full disclosure of the study authors, visit

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