Progress in Progression-Free Survival

Non small cell lung cancer with EGFR mutations responded better to afatinib than chemotherapy

(RxWiki News) Changes in genes are at the heart of many cancers. One gene mutation shows up in about 10 percent of lung cancers. That gene is known as the epidermal growth factor receptor (EGFR).

A recently completed clinical trial showed that this genetic change has a powerful new enemy.

Non-small cell lung cancers (NSCL) with EGFR mutations were stable longer and responded better in patients treated with afatinib than patients treated with chemotherapy.

Afatinib is currently under review by the US Food and Drug Administration (FDA) and has not yet been approved.

"Find out if genetic testing could identify treatment options."

Lecia V. Sequist,  MD, MPH, associate professor of medicine at Harvard Medical School and assistant physician at Massachusetts General Hospital in Boston, was the lead investigator of this phase III clinical trial called LUX-Lung 3.

Dr. Sequist and colleagues were looking for what’s known as progression-free survival — the length of time before the cancer gets worse.

A total of 1,269 NSCL patients were screened for EGRF mutations. Individuals who had EGFR mutations were grouped by the type of mutation they had — what’s known as the exon 19 deletion, L858R or other.

Of those screened, 345 individuals with EGFR mutations were randomly assigned to receive either 40 mg of afatinib daily or up to six cycles of chemotherapy (cisplatin plus pemetrexed) every 21 days.

Those treated with afatinib had a progression-free survival of 11.1 months compared to 6.9 months for patients treated with chemotherapy.

Patients who had 19 deletions and L858R EGFR mutations fared even better. These individuals had a progression-free survival of 13.6 months compared to the 6.9 months for those on chemotherapy.

"While improvement of progression-free survival, response rate and lung cancer-related symptoms are extremely important and greatly achieved with afatinib as a single agent treatment, the ultimate goal is the cure for this subgroup of patients, which could be achievable," Fred R. Hirsch, MD, PhD,  professor of medicine and pathology at the University of Colorado Cancer Center, told dailyRx News.

"However, future combination therapy seems necessary, and we need to learn more about resistance mechanisms and how to combine the new agents with or without more established cancer agents," said Dr. Hirsch, who was not involved in the study.

Afatinib is also currently being studied as a possible therapy for other cancers.

This study was published July 1 in the Journal of Clinical Oncology

A number of the authors disclosed having financial ties with the maker of afatinib, Boehringer Ingelheim, and other pharmaceutical companies and commercial entities.

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Review Date: 
July 5, 2013