Dacomitinib vs. Gefitinib in First-Line Treatment of EGFR Mutation–Positive NSCLC
“Dacomitinib should be considered as a new first-line treatment option” in patients with advanced epidermal growth factor receptor (EGFR) mutation–positive non–small cell lung cancer (NSCLC), Yi-Long Wu, MD, of the Guangdong Lung Cancer Institute in Guangzhou, China, and colleagues concluded in reporting the results of the phase III ARCHER 1050 trial in The Lancet Oncology. The second-generation, irreversible EGFR tyrosine kinase inhibitor dacomitinib was compared with the reversible tyrosine kinase inhibitor gefitinib.
In this open-label study, 452 patients were randomly assigned to receive either dacomitinib or gefitinib, both oral agents. Each patient had NSCLC and one EGFR mutation (exon 19 deletion or Leu858Arg).
As judged by masked independent review, the median progression-free survival was 14.7 months with dacomitinib versus 9.2 months with gefitinib. The treatments continued until disease progression or another discontinuation criterion was reached.
The most common grade 3 or 4 adverse events were dermatitis acneiform (14% of dacomitinib patients but 0% of the gefitinib group); diarrhea (8% of dacomitinib patients and 1% of the gefitinib group); and increased alanine aminotransferase levels (1% of the dacomitinib group and 8% of gefitinib patients).