Impact of Afatinib Dose Modification on Safety and Effectiveness in Patients with EGFR Mutation-Positive Advanced NSCLC: Results from a Global Real-World Study (RealGiDo)
Menée dans 13 pays à partir des dossiers médicaux de 228 patients atteints d'un cancer du poumon non à petites cellules de stade avancé et présentant une mutation EGFR, cette étude évalue la toxicité, du point de vue de l'incidence et de la sévérité des événements indésirables liés au traitement, et l'efficacité, du point de vue de la durée avant échec du traitement et la durée avant progression de la maladie, d'une modification de doses d'afatinib dispensé en traitement de première ligne
Objectives : In the LUX-Lung clinical trials of afatinib in EGFR mutation-positive NSCLC, tolerability-guided dose adjustment reduced the incidence and severity of adverse events while maintaining efficacy. The RealGiDo study evaluated the impact of afatinib dose adjustment in a real-world setting. Materials and methods : This non-interventional, observational study used medical records of EGFR mutation-positive NSCLC patients treated with first-line afatinib. Primary outcomes were adverse drug reaction (ADR) incidence and severity, time to treatment failure (TTF), and time to progression (TTP), relative to LUX-Lung 3 (LL3). Results : 228 patients were enrolled from 13 countries. Baseline characteristics were in line with LL3 but with more Del19 patients (78.1% vs. 49.0%) and fewer Asian patients (43.9% vs. 72.2%); 11.8% had ECOG performance status 2–3. A total of 71 (31.1%) received a modified starting dose of ≤30 mg. Of patients who started with 40 mg, 67.1% underwent dose reductions, 86.5% of which were in the first 6 months. Dose reductions were mainly due to ADRs and were more common in female, East Asian, and low body-weight patients. There were no new safety signals and fewer ≥ grade 3 ADRs (28.4% vs. 48.9%) and serious adverse events (5.2% vs. 14.0%) than in LL3. Median TTF and TTP were 18.7 and 20.8 months, respectively, and were not impacted by reduced starting dose or dose modification. Conclusion : Real-world data show that afatinib dose adjustments reduced the frequency and intensity of ADRs without compromising effectiveness, highlighting the benefit of tailoring afatinib dose to optimise treatment outcomes and supporting clinical decision-making.