Abstract
BackgroundLimited treatment options exist for relapsed advanced lung squamous cell carcinoma (SCC), leading to poor outcomes compared with adenocarcinoma. This study aimed to investigate the efficacy of second-line afatinib versus chemotherapy in patients with advanced lung SCC who progressed after first-line chemotherapy.MethodsIn this retrospective, multisite cohort study, we recruited patients with initial locally advanced or metastatic lung SCC from four institutes in Taiwan between June 2014 and October 2020. The primary endpoint of this study was progression-free survival (PFS), and the secondary endpoints were the objective response rate (ORR), disease control rate (DCR), and overall survival (OS).ResultsThe present study enrolled 108 patients: 19 received second-line afatinib, and 89 received second-line chemotherapy. The median ages were 71 and 67 years, respectively. PFS was significantly longer among patients who received afatinib than among those who received chemotherapy (median 4.7 months [95% confidence interval (CI), 0.1–7.5] vs. 2.6 months [95% CI, 0.9–6.7]; hazard ratio (HR) 0.53 [95% CI 0.32–0.88], p = 0.013). Compared with the chemotherapy group, OS was longer in the afatinib group but did not reach significance (median 16.0 months [95% CI, 6.1–22.0] vs. 12.3 months [6.2–33.9]; HR 0.65 [95% CI 0.38–1.11], p = 0.112).ConclusionsAfatinib offered a longer PFS and comparable OS to chemotherapy in advanced lung SCC patients in a real-world setting, it may be considered as a 2nd line alternative treatment choice for immunotherapy unfit advanced lung SCC patients.
Highlights
Limited treatment options exist for relapsed advanced lung squamous cell carcinoma (SCC), leading to poor outcomes compared with adenocarcinoma
Mutations are infrequently observed in the genes encoding members of the ErbB family of receptor tyrosine kinases, and targeted therapy is available for these cases [6]; the nature of mutations identified in lung SCC differs considerably from those identified in lung adenocarcinoma, resulting in sizable differences in treatment efficacy [7]
Overall, 108 patients were identified for inclusion during the study period and formed the original cohort: 19 received afatinib, and 89 received chemotherapy as second-line treatment (Table 1)
Summary
Limited treatment options exist for relapsed advanced lung squamous cell carcinoma (SCC), leading to poor outcomes compared with adenocarcinoma. Among NSCLC, lung squamous cell carcinoma (SCC) is the second most common histology type, accounting for 20–30% of cases [2, 3]. The treatment of lung adenocarcinoma has evolved considerably due to the emergence of targeted therapies against identified molecular drivers, such as epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), c-ros oncogene 1 (ROS1), and murine sarcoma viral oncogene homolog B (BRAF). Mutations are infrequently observed in the genes encoding members of the ErbB family of receptor tyrosine kinases, and targeted therapy is available for these cases [6]; the nature of mutations identified in lung SCC differs considerably from those identified in lung adenocarcinoma, resulting in sizable differences in treatment efficacy [7]. For advanced NSCLC patients with no targetable molecular drivers, platinum-based doublet chemotherapy has long been the standard first-line treatment, with good performance status, until the recent introduction of immunotherapy [8, 9]
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