Safety and efficacy of afatinib for the treatment of non-small-cell lung cancer following osimertinib-induced interstiti
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SHORT REPORT
Safety and efficacy of afatinib for the treatment of non-small-cell lung cancer following osimertinib-induced interstitial lung disease: A retrospective study Shingo Nasu 1 & Hidekazu Suzuki 1 & Takayuki Shiroyama 1 & Ayako Tanaka 1 & Yumiko Samejima 1 & Tomohiro Kanai 1 & Yoshimi Noda 1 & Naoko Morishita 1 & Norio Okamoto 1 & Tomonori Hirashima 1 Received: 19 May 2020 / Accepted: 11 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Summary Background Osimertinib is one of the first-line treatments for advanced non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. However, the occurrence rate of osimertinib-induced interstitial lung disease (ILD) is particularly high in Japanese patients and little information on subsequent cancer treatment options after recovery from osimertinib-induced ILD is currently available. Thus, this study aims to determine the safety and efficacy of afatinib for the treatment of NSCLC following osimertinib-induced ILD. Methods We retrospectively investigated the clinical courses of all NSCLC patients with EGFR mutations at our facility between August 2018 and September 2019, who received osimertinib as first-line treatment and were subsequently treated with afatinib after developing osimertinib-induced ILD. Results Forty-two patients received osimertinib treatment at our facility during the study period, and four patients received afatinib after developing osimertinib-induced ILD. All events of ILD improved either spontaneously or with steroid therapy before the initiation of afatinib. For the four patients who were retrospectively reviewed, the overall response rate to afatinib therapy was 75%, and the disease control rate was 100%. During the study period, no ILD recurrence was observed in any of the four patients. Conclusions According to our study findings, afatinib treatment after osimertinib-induced ILD is considered safe and effective and it can be used as one of the treatment options for NSCLC following osimertinib-induced ILD. Keywords Afatinib . Drug-induced interstitial lung disease . Osimertinib . Epidermal growth factor receptor mutation
Introduction Osimertinib is an oral, irreversible, third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) with activity against both EGFR-TKI-sensitizing mutations and the T790M resistance mutation [1–3]. In the phase 3 FLAURA trial, the progression-free survival (PFS) and overall survival (OS) of patients treated with osimertinib were significantly better than those of patients treated with erlotinib or gefitinib as first-line treatment for EGFR-mutated advanced non-small-cell lung cancer (NSCLC) [2, 3]. Despite its proven efficacy, the occurrence rate of osimertinib-induced interstitial
lung disease (ILD) in the Japanese subset of the FLAURA study was particularly higher (12.3%) than that in the general population (4%) [2, 4]. Moreover, there is little information regarding subsequent cancer treatment options after recover
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