Comparison of epidermal growth factor receptor tyrosine kinase inhibitors for patients with lung adenocarcinoma harboring different epidermal growth factor receptor mutation types

• Published in: BMC cancer Vol. 21; no. 1; p. 52
• Main Authors: Park, Sojung, Lee, Sung Yong, Kim, Dojin, Sim, Yun Su, Ryu, Jeong-Seon, Choi, Juwhan, Lee, Su Hwan, Ryu, Yon Ju, Lee, Jin Hwa, Chang, Jung Hyun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.01.2021; BioMed Central; BMC
• Subjects: Adenocarcinoma; Adenocarcinoma of Lung - drug therapy; Adenocarcinoma of Lung - genetics; Adenocarcinoma of Lung - pathology; Aged; Biomarkers, Tumor - genetics; Biopsy; Body mass index; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - pathology; Care and treatment; Diagnosis; Epidermal growth factor; Epidermal growth factor receptor; Epidermal growth factor receptors; ErbB Receptors - genetics; Female; Follow-Up Studies; Gefitinib; Gene deletion; Gene mutations; Health aspects; Humans; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Lung Neoplasms - pathology; Male; Multivariate analysis; Mutation; Non-small cell lung cancer; Non-small cell lung carcinoma; Patient outcomes; Patients; Point mutation; Prognosis; Protein Kinase Inhibitors - therapeutic use; Protein-tyrosine kinase receptors; Retrospective Studies; Survival; Survival Rate; Tyrosine kinase inhibitor; South Korea; Adenocarcinoma; Tyrosine kinase inhibitor; Survival; Epidermal growth factor receptor; Non-small cell lung cancer
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-07765-6

Epidermal growth factor receptor (EGFR) mutations in non-small-cell lung cancer predict sensitivity to EGFR tyrosine kinase inhibitors (TKIs). EGFR mutation types are associated with efficacy of EGFR TKIs. We investigated the clinical outcomes of afatinib, erlotinib, and gefitinib according to EGFR mutation type in patients with lung adenocarcinoma. Between May 2010 and December 2018, we investigated 363 patients with advanced lung adenocarcinoma harboring EGFR mutations who received EGFR TKIs. Efficacies of EGFR TKIs such as response rate, progression-free survival (PFS), and overall survival (OS) were retrospectively evaluated according to exon 19 deletion (E19del), L858R point mutation (L858R) and uncommon mutations. The frequency of E19del was 48.2%, that of L858R was 42.4%, and that of uncommon mutations was 9.4%. E19del and L858R were associated with superior PFS and OS compared with uncommon mutations. Erlotinib showed significantly inferior OS than other TKIs (30.8 ± 3.3 in erlotinib vs. 39.1 ± 4.3 in afatinib vs. 48.4 ± 6.3 in gefitinib; p = 0.031) in patients with L858R. Gefitinib showed significantly inferior PFS (4.6 ± 1.1 in gefitinib vs. 11.6 ± 2.7 in afatinib vs. 10.6 ± 2.7 in erlotinib; p = 0.049) in patients with uncommon mutations. Afatinib was significantly associated with a longer PFS, presenting constant effectiveness in all EGFR mutation types. Caution may be needed on the use of erlotinib for L858R and the use of gefitinib for uncommon EGFR mutations.