Irreversible Tyrosine Kinase Inhibition of Epidermal Growth Factor Receptor with Afatinib in Egfr Activating Mutation–Positive Advanced Non-Small-Cell Lung Cancer

S Morin–Ben Abdallah,V Hirsh

doi:10.3747/co.25.3732

Abstract

Despite recent advances in the systemic therapy of non-small-cell lung cancer (nsclc), the prognosis for stage iv disease remains poor. The discovery of targetable mutations has led to new treatment options. The most common mutations, the EGFR activating mutations, are present in about 50% of Asian patients and up to 15% of white patients. First-generation reversible epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) have led to improved survival in patients positive for EGFR activating mutations, but resistance eventually leads to disease progression. The irreversible egfr tki afatinib was developed to counter such resistance. The clinical efficacy of afatinib has been shown in first-line studies comparing it with both cytotoxic chemotherapy and first-generation egfr tkis. Afatinib has also shown continued benefit beyond progression while a patient is taking an egfr inhibitor. Furthermore, its toxicity profile is both predictable and manageable. The results of the principal clinical trials assessing afatinib are reviewed here.

Highlights

In 2019, the Canadian Cancer Statistics Advisory Committee estimated that 29,300 Canadians are diagnosed with lung cancer annually and 21,000 die from it [1]
The only patients with a prospect of cure are those with early stage non-small cell lung cancer (NSCLC) who are amenable to surgical resection with curative intent [2]
Our objective was to quantify the effect of the COVID-19 pandemic on surgical lung cancer care as perceived by practicing thoracic surgeons during the first wave of the pandemic in Canada

Summary

Introduction

In 2019, the Canadian Cancer Statistics Advisory Committee estimated that 29,300 Canadians are diagnosed with lung cancer annually and 21,000 die from it [1]. In the era of COVID-19, routine lung cancer physiologic and staging assessments are unique in that they are droplet producing and aerosolizing procedures. These include pulmonary function testing (PFT), endobronchial ultrasound, and bronchoscopy [4]. Routine lung cancer physiologic and staging assessments are unique in that they are droplet producing and aerosolizing procedures. Our objective was to quantify the effect of the COVID-19 pandemic on surgical lung cancer care as perceived by practicing thoracic surgeons during the first wave of the pandemic in Canada. Assessing the extent and effects of newly present barriers to standard lung cancer care is essential in forming appropriate mitigation strategies and planning for future pandemic waves

Objectives

Methods

Results

Discussion

Conclusion