Non-Small Cell Lung Cancer Coverage from Every Angle

Global Study of Sequential Afatinib and Osimertinib in EGFR Mutation–Positive NSCLC

By: Victoria Kuhr, BA
Posted: Wednesday, January 12, 2022

The sequential use of the kinase inhibitors afatinib and osimertinib demonstrated antitumor activity in patients with EGFR mutation–positive non–small cell lung cancer (NSCLC) and acquired T790M, according to Sanjay Popat, BSc, MBBS, FRCP, PhD, of Royal Marsden National Health Service Foundation Trust, London, and colleagues. Additionally, the authors observed the incidence of brain metastases remained stable prior to, and after, afatinib treatment. A detailed report of the study was published in the journal Lung Cancer.

“Given the real-world setting, the observation of comparable overall responsive rates with first-line afatinib in this study and prospective trials was encouraging,” said the authors.

The non-interventional, global, multicenter UpSwinG study recruited patients from across nine countries (United Kingdom, Taiwan, South Korea, Japan, France, Germany, Austria, Spain, Italy) between November 2019 and July 2020. All patients had EGFR mutation–positive (del19 or L858R), tyrosine kinase inhibitor–naive, advanced NSCLC and were treated with first-line afatinib; following detection of T790M, patients received second-line osimertinib. Additionally, all patients must have started osimertinib treatment at least 10 months prior to data entry but did not need to still be on treatment. The study measured 191 patients’ time to treatment failure, overall survival, and overall response rate.

At the start of the afatinib treatment, 14% of patients had brain metastases. At the start of osimertinib treatment, 14% had brain metastases (rising to 29% at the end of osimertinib treatment). The source of biopsy material (solid/liquid) was 86%/3% at the start of afatinib and 54%/33% at the start of osimertinib. Overall, the median time to treatment failure was 27.7 months, and the median overall survival was 36.5 months. In fact, the highest overall survival (43.8 months) was observed in Asian patients who had EGFR del19 mutations. The overall response rates with afatinib and osimertinib were 74% and 45%, respectively. These outcomes were generally consistent across subgroups.

Disclosure: For full disclosures of study authors, visit

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