Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan
Background: Afatinib and Osimertinib are first-line treatments for EGFR-mutated advanced non-small cell lung cancer (NSCLC), but their comparative efficacies and the patient groups that benefit the most remain unclear. This multicenter retrospective study evaluated the efficacy of first-line Afatini...
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2025-01-01
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| Series: | Current Oncology |
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| author | Jerry Shu-Hung Kuo Cheng-Yu Chang Shih-Chieh Chang Yu-Feng Wei Chung-Yu Chen |
| author_facet | Jerry Shu-Hung Kuo Cheng-Yu Chang Shih-Chieh Chang Yu-Feng Wei Chung-Yu Chen |
| author_sort | Jerry Shu-Hung Kuo |
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| description | Background: Afatinib and Osimertinib are first-line treatments for EGFR-mutated advanced non-small cell lung cancer (NSCLC), but their comparative efficacies and the patient groups that benefit the most remain unclear. This multicenter retrospective study evaluated the efficacy of first-line Afatinib and Osimertinib in NSCLC patients with EGFR 19del and no brain metastases at diagnosis. Methods: The primary endpoints were time on treatment (ToT) and overall survival (OS). Survival analyses were performed for three groups: Afatinib followed by Osimertinib, Afatinib followed by other therapies, and Osimertinib (alone or followed by other therapies). Rebiopsy practices, including T790M mutation detection, were also analyzed in patients with disease progression on Afatinib. Results: Among 97 Afatinib-treated and 60 Osimertinib-treated patients, Osimertinib showed a significantly longer ToT (23.3 vs. 16.5 months; <i>p</i> = 0.007). Median OS was numerically higher for Afatinib with sequential Osimertinib (40.5 vs. 34.6 months for Osimertinib; <i>p</i> = 0.473). Osimertinib demonstrated advantages, with fewer brain metastases upon progression and fewer adverse effects. In the Afatinib group, 64% of patients with disease progression underwent rebiopsy, with 39% testing positive for T790M mutation and subsequently receiving Osimertinib. Rebiopsy was most frequently performed on the lung parenchyma using non-surgical methods. Conclusions: In this real-world study, Osimertinib achieved a significantly longer ToT compared to Afatinib in NSCLC patients with EGFR 19del and no brain metastases. The sequential use of Afatinib followed by Osimertinib showed a trend toward improved OS, highlighting the importance of rebiopsy for identifying T790M mutations to guide subsequent therapy. |
| format | Article |
| id | doaj-art-a97cbc5cce7d4e4bb6e6461d60a74c95 |
| institution | Kabale University |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Current Oncology |
| spelling | doaj-art-a97cbc5cce7d4e4bb6e6461d60a74c952025-01-24T13:28:26ZengMDPI AGCurrent Oncology1198-00521718-77292025-01-013213610.3390/curroncol32010036Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in TaiwanJerry Shu-Hung Kuo0Cheng-Yu Chang1Shih-Chieh Chang2Yu-Feng Wei3Chung-Yu Chen4Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Douliu City 640, TaiwanDivision of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, TaiwanDivision of Chest Medicine, Department of Internal Medicine, National Yang-Ming Chiao Tung University Hospital, Yilan County, Yilan City 260, TaiwanDepartment of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 824, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Douliu City 640, TaiwanBackground: Afatinib and Osimertinib are first-line treatments for EGFR-mutated advanced non-small cell lung cancer (NSCLC), but their comparative efficacies and the patient groups that benefit the most remain unclear. This multicenter retrospective study evaluated the efficacy of first-line Afatinib and Osimertinib in NSCLC patients with EGFR 19del and no brain metastases at diagnosis. Methods: The primary endpoints were time on treatment (ToT) and overall survival (OS). Survival analyses were performed for three groups: Afatinib followed by Osimertinib, Afatinib followed by other therapies, and Osimertinib (alone or followed by other therapies). Rebiopsy practices, including T790M mutation detection, were also analyzed in patients with disease progression on Afatinib. Results: Among 97 Afatinib-treated and 60 Osimertinib-treated patients, Osimertinib showed a significantly longer ToT (23.3 vs. 16.5 months; <i>p</i> = 0.007). Median OS was numerically higher for Afatinib with sequential Osimertinib (40.5 vs. 34.6 months for Osimertinib; <i>p</i> = 0.473). Osimertinib demonstrated advantages, with fewer brain metastases upon progression and fewer adverse effects. In the Afatinib group, 64% of patients with disease progression underwent rebiopsy, with 39% testing positive for T790M mutation and subsequently receiving Osimertinib. Rebiopsy was most frequently performed on the lung parenchyma using non-surgical methods. Conclusions: In this real-world study, Osimertinib achieved a significantly longer ToT compared to Afatinib in NSCLC patients with EGFR 19del and no brain metastases. The sequential use of Afatinib followed by Osimertinib showed a trend toward improved OS, highlighting the importance of rebiopsy for identifying T790M mutations to guide subsequent therapy.https://www.mdpi.com/1718-7729/32/1/36AfatinibOsimertinibEGFR mutationlung cancerrebiopsy |
| spellingShingle | Jerry Shu-Hung Kuo Cheng-Yu Chang Shih-Chieh Chang Yu-Feng Wei Chung-Yu Chen Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan Current Oncology Afatinib Osimertinib EGFR mutation lung cancer rebiopsy |
| title | Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan |
| title_full | Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan |
| title_fullStr | Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan |
| title_full_unstemmed | Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan |
| title_short | Rebiopsy Enhances Survival with Afatinib vs. Osimertinib in EGFR Exon 19 Deletion Non-Small Cell Lung Cancer: A Multicenter Study in Taiwan |
| title_sort | rebiopsy enhances survival with afatinib vs osimertinib in egfr exon 19 deletion non small cell lung cancer a multicenter study in taiwan |
| topic | Afatinib Osimertinib EGFR mutation lung cancer rebiopsy |
| url | https://www.mdpi.com/1718-7729/32/1/36 |
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