Tyrosine kinase inhibitors in first-line treatment of advanced NSCLC with epidermal growth factor receptor mutations: Real-world data from Vietnam.

Aims: The study aimed to evaluate the effectiveness and adverse events of tyrosine kinase inhibitors (TKIs) in the first-line treatment of advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations.

Methods: A retrospective study on advanced NSCLC patients with EGFR mutations treated with TKIs as a first-line therapy at Nghe An Oncology Hospital, Vietnam between January 2017 and August 2023. The primary endpoints included objective response rate, progression-free survival, and tolerability. The secondary endpoint was overall survival.

Results: A total of 211 patients received first-line treatment with Erlotinib (n = 74), Gefitinib (n = 85), Afatinib (n = 34) or Osimertinib (n = 18). The overall response rate was 76.7%, with Osimertinib at 83.4%, Afatinib at 73.6%, Erlotinib at 77.1%, and Gefitinib at 76.5%. The median progression-free survival in the Gefitinib group was 12.2 months (95% CI: 11.1-13.2), 13.4 months (95% CI: 10.6-16.2) in the Erlotinib group, 18.4 months (95% CI: 10.1-26.8) in the Afatinib group and 25.3 months in the Osimertinib group (p = 0.001). The median overall survival was 21.8 months (95% Cl: 15.0-28.4) in the Gefitinib group, 30 months (95% Cl: 19.1-40.9) in the Erlotinib group (p = 0.154). Most drug-related adverse events were grade 1 or 2. Diarrhea was the most frequent adverse event in the Afatinib group at 44.1%; rash was most common in the Erlotinib group at 60.8%; paronychia (31.8%), and interstitial lung disease (3.5%) were most frequent in the Gefitinib group.

Conclusion: The TKIs as first-line therapies for advanced NSCLC patients with EGFR mutated are highly effective, prolong survival, and are well tolerated.