A multicenter cohort study of osimertinib compared with afatinib as first-line treatment for EGFR-mutated non-small-cell lung cancer from practical dataset: CJLSG1903

• Published in: ESMO open 2021-06, Vol.6 (3), p.100115-100115, Article 100115
• Main Authors: Ito, K., Morise, M., Wakuda, K., Hataji, O., Shimokawaji, T., Takahashi, K., Furuya, N., Takeyama, Y., Goto, Y., Abe, T., Kato, T., Ozone, S., Ikeda, S., Kogure, Y., Yokoyama, T., Kimura, M., Yoshioka, H., Murotani, K., Kondo, M., Saka, H.
• Format: Article
• Language: English
• Subjects: Acrylamides; afatinib; Afatinib - therapeutic use; Aniline Compounds; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Cohort Studies; EGFR mutation; ErbB Receptors - genetics; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; non-small-cell lung cancer; Original Research; osimertinib; Prospective Studies; real world data
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2021.100115

FLAURA, the prospective trial of osimertinib as a first-line therapy compared with first-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), did not show superior survival benefit for osimertinib in either the subgroup of Asians or the subgroup with the L858R mutation. In addition, the superiority of osimertinib compared with second-generation EGFR-TKI is thus far unclear. We reviewed the clinical data of all consecutive patients who were treated with osimertinib or afatinib as first-line therapy between May 2016 and October 2019 from 15 institutions in Japan. We defined the groups based on first-line EGFR-TKI as the afatinib group and the osimertinib group. Outcomes included time to discontinuation of any EGFR-TKI (TD-TKI), overall survival (OS), and time to treatment failure, with propensity score analysis carried out as an exploratory analysis in the survival and subgroup analyses. A total of 554 patients were enrolled. Data on 326 patients in the osimertinib group, and 224 patients in the afatinib group were analyzed. TD-TKI adjusted by propensity score in the afatinib and osimertinib groups was 18.6 months (95% confidence interval 15.8 to 22.0) and 20.5 months (95% confidence interval 13.8 to not reached), respectively, without significant difference (P = 0.204). OS adjusted by propensity score favored the afatinib group with a significant difference (P = 0.018). Subgroup analysis with propensity score showed that patients with L858R and without brain metastasis had superior survival benefit with afatinib compared with osimertinib (P < 0.001). TD-TKI in the afatinib group was not significantly prolonged compared with the osimertinib group in the practical data. In the exploratory analysis of patients with L858R-mutated non-small-cell lung cancer without brain metastasis, afatinib showed more benefit in OS over osimertinib. •The large-scale practical data of 550 patients who were treated with osimertinib or afatinib as first-line therapy were analyzed.•The superiority of osimertinib compared with afatinib could not be demonstrated in all populations.•Osimertinib therapy showed effectiveness in patients with brain metastasis.•Afatinib therapy showed potential benefit in patients with L858R mutation and without brain metastasis.