578P - Tyrosine kinase inhibitor treatment of elderly patients with epidermal growth factor receptor mutated advanced non-small cell lung cancer: A multi-institute retrospective study

Background

This study aimed to describe efficacy and safety of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for elderly patients (≥65 years) with treatment-naïve EGFR-mutated advanced non-small cell lung cancer (NSCLC).

Methods

Patients with treatment-naïve EGFR-mutated advanced NSCLC were enrolled at several hospitals in Taiwan between May 2014 and January 2018. Patient characteristics, including age, sex, performance status (PS), smoking history, tumor morphology, mutation type, stage, metastasis, efficacy and safety of EGFR-TKIs were compared. Univariate and multivariate analyses were performed to explore possible prognostic factors.

Results

This study enrolled 1,343 patients with treatment-naïve EGFR-mutated advanced NSCLC, of which 554 were aged <65 years, 383 were aged 65–74 years, 323 were aged 75–84 years, and 83 were aged ≥85 years. In elderly patients, afatinib showed significantly better efficacy, with a median progression-free survival (PFS) of 14.7 months and overall survival (OS) of 22.2 months, than gefitinib (9.9 months and 17.7 months, respectively) and erlotinib (10.8 months and 18.5 months, respectively; PFS: p=0.003; OS: p=0.026). However, patients treated with afatinib also experienced more grade ≥3 adverse events than those treated with gefitinib and erlotinib, including skin toxicities (6.1% vs. 1.8% vs. 3.9%, p=0.052), paronychia (5.1% vs. 0.5% vs. 2.3%, p=0.006), mucositis (1.9% vs. 0% vs. 1.1%, p=0.122), and diarrhea (9.3% vs. 2.3% vs. 1.5%, p<0.0001). PS of 2-4, stage IV disease, liver, bone, pleura, adrenal, and pericardial metastases, and EGFR-TKI treatment with gefitinib were associated with poor PFS, while age of ≥ 85 years, PS of 2-4, stage IV disease, liver, brain, bone, pleura, adrenal, and pericardial metastases, and EGFR-TKI treatment with gefitinib were associated with poor OS. These factors were independent prognostic factors for both PFS and OS.

Conclusions

For elderly patients with EGFR-mutated advanced NSCLC, afatinib was associated with better efficacy than gefitinib or erlotinib in elderly patients with EGFR-mutated advanced NSCLC as a first-line treatment with acceptable AEs.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.