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. 2020 Apr;16(2):e113-e117.
doi: 10.1111/ajco.13103. Epub 2018 Dec 2.

The effects of switching EGFR-TKI treatments for non-small cell lung cancer because of adverse events

Yoshihiko Sakata  1 , Kodai Kawamura  1 , Naoki Shingu  1 , Shigeo Hiroshige  1 , Yuko Yasuda  1 , Yoshitomo Eguchi  1 , Keisuke Anan  1 , Junpei Hisanaga  1 , Tatsuya Nitawaki  1 , Aiko Nakano  1 , Kazuya Ichikado  1
Affiliations

The effects of switching EGFR-TKI treatments for non-small cell lung cancer because of adverse events

Yoshihiko Sakata et al. Asia Pac J Clin Oncol. 2020 Apr.

Abstract

Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are used to treat patients with non-small cell lung cancer (NSCLC) and EGFR driver mutations. Although some patients discontinued these treatments because of adverse events, it is unclear whether switching EGFR-TKI because of adverse events provides a benefit.

Methods: This retrospective study evaluated data from 22 patients with EGFR mutation-positive NSCLC who received at least two EGFR-TKIs that were switched because of adverse events (March 2011 to September 2017). Progression-free survival 2 (PFS2) was defined as the time from starting of the first EGFR-TKI treatment to disease progression during the second EGFR-TKI treatment.

Results: Seventeen patients received gefitinib as the first EGFR-TKI treatment, while four patients received afatinib and one patient received erlotinib. The median time to failure of the first EGFR-TKI treatment was 1.6 months. The EGFR-TKIs were switched because of hepatotoxicity (n = 16), interstitial lung disease (n = 3), and other reasons (n = 3). The median washout period was 1.1 months. Seventeen patients received erlotinib as the second EGFR-TKI treatment, while three patients received gefitinib and two patients received afatinib. The median PFS for the second EGFR-TKI treatment was 15.2 months. The median PFS2 was 17.7 months and the median overall survival was 32.8 months.

Conclusions: Switching EGFR-TKIs because of adverse events provided a clinical benefit for patients with EGFR mutation-positive NSCLC. Appropriate judgment regarding switching from one EGFR-TKI to another may improve the performance status and prognosis of patients with EGFR mutation-positive NSCLC.

Keywords: epidermal growth factor receptor; non-small cell lung cancer; tyrosine kinase inhibitor.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
The swimmer plots for durations of the first and second EGFR‐TKI treatments. Black arrows indicate that the patient is still receiving treatment. TTF, time to treatment failure; TKI, tyrosine kinase inhibitor; PFS, progression‐free survival [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Progression‐free survival from the start of the first EGFR‐TKI treatment to progression during the second EGFR‐TKI treatment (PFS2). CI, confidence interval
Figure 3
Figure 3
Overall survival among all patients. CI, confidence interval
See this image and copyright information in PMC

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