Afatinib After Progression on Osimertinib in EGFR-Mutated Non-Small Cell Lung Cancer. (2022)

• Record Type: Journal Article
• Authors: Aredo, Jacqueline V; Wakelee, Heather A; Neal, Joel W; Padda, Sukhmani K
• Is Part Of: Cancer treatment and research communications. Number 30(2022)
• Publication Date: 2022
• Subjects: EGFR mutation -- osimertinib -- afatinib -- cetuximab -- EGFR TKI
• DOI: 10.1016/j.ctarc.2021.100497
• Languages: English
• ISSNs: 2468-2942

Abstract

Highlights: Afatinib has limited activity in EGFR -mutant NSCLC after progression on osimertinib Response to prior osimertinib may be predictive of response to afatinib Osimertinib resistance mechanisms may play a key role in selecting for afatinib ABSTRACT: Introduction: After the development of acquired resistance to osimertinib, the standard-of-care treatment for advanced EGFR -mutated NSCLC is chemotherapy. Whether afatinib, a pan-ErbB family tyrosine kinase inhibitor, is active after progression on osimertinib is unknown. Methods: We conducted a single-institution retrospective analysis of patients with advanced EGFR -mutated NSCLC who received afatinib-containing therapy after progression on osimertinib. Kaplan-Meier analyses evaluated progression-free survival (PFS) and overall survival (OS) from initiation of afatinib. Results: After progression on first (N=3) or second-line plus (N=12) osimertinib, 15 patients received afatinib monotherapy (N=3), afatinib and cetuximab (N=10), or afatinib and bevacizumab (N=2). The objective response rate was 6.7% and disease control rate was 53.3%. Median PFS was 2.5 months and median OS was 7.7 months. Median PFS of ≥ 6 months versus < 6 months on osimertinib was associated with a significantly greater median PFS on afatinib (4.0 versus 1.4 months; P=0.003), although there was no significant difference in median OS (9.3 versus 6.6 months; P=0.123). Best response of stable disease/partial response versus progressive disease on osimertinib was associated with a significantly greater median PFS on afatinib (3.4 versus 1.6 months; P=0.036) and a significantly greater median OS (8.7 versus 4.6 months; P=0.017). Conclusion: Afatinib-containing therapy had limited activity in patients with EGFR -mutated NSCLC after progression on osimertinib in this cohort of mostly second-line plus osimertinib. Response and longer PFS to prior osimertinib may be predictive of response to afatinib. Strategies based on osimertinib resistance mechanisms may further define the role of subsequent afatinib.