Efficacy and Prognosis of First-Line EGFR-Tyrosine Kinase Inhibitor Treatment in Older Adults Including Poor Performance Status Patients with EGFR-Mutated Non-Small-Cell Lung Cancer

Cheng-Yu Chang; Chung-Yu Chen; Shih-Chieh Chang; Yi-Chun Lai; Yu-Feng Wei

doi:10.2147/CMAR.S322967

Efficacy and Prognosis of First-Line EGFR-Tyrosine Kinase Inhibitor Treatment in Older Adults Including Poor Performance Status Patients with EGFR-Mutated Non-Small-Cell Lung Cancer

Cancer Manag Res. 2021 Sep 15:13:7187-7201. doi: 10.2147/CMAR.S322967. eCollection 2021.

Authors

Cheng-Yu Chang^#¹, Chung-Yu Chen^#^{2

3}, Shih-Chieh Chang^#^{4

5

6}, Yi-Chun Lai^{4

5}, Yu-Feng Wei^{7

8

9}

Affiliations

¹ Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
² Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
³ College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Division of Chest Medicine, Department of Internal Medicine, National Yang-Ming Chiao Tung University Hospital, Yi-Lan, Taiwan.
⁵ Faculty of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
⁶ Department of Critical Care Medicine, National Yang-Ming Chiao Tung University Hospital, Yi-Lan, Taiwan.
⁷ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁸ Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan.
⁹ Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan.

^# Contributed equally.

Abstract

Introduction: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are standard first-line treatments for advanced EGFR-mutated non-small-cell lung cancer (NSCLC) patients. The efficacy of EGFR-TKIs in older patients including poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) is seldom investigated.

Methods: We enrolled patients 65 years or older with EGFR-mutated Stage IIIB-IV NSCLC and evaluated the efficacy and prognosis of first-line EGFR-TKI treatment. Clinical and demographic characteristics were reviewed and analyzed, including age, sex, PS, smoking history, EGFR mutation type, treatment regimen, progression-free survival (PFS), and overall survival (OS).

Results: From January 2015 to December 2019, a total of 237 patients were included, 205 of whom were eligible for efficacy and outcome analyses. Among them, 91 (44.4%) were categorized as poor PS (2-4). Compared with patients categorized as good PS (0-1), those with poor PS were older (79 versus 75 years), had a higher proportion of brain metastases (41.8% versus 25.4%), more comorbidities (74.7% versus 54.4%), and more likely to be treated with first-generation TKIs (74.7% versus 57.0%). The PFS and OS were 17.1 and 26.7 months respectively in patients with good PS and 12.7 and 18.2 months in those with poor PS (both p < 0.001). In the multivariate analysis, good PS, <3 metastatic sites, and first-line treatment with afatinib compared with erlotinib and gefitinib were associated with longer PFS. A relatively younger age, good PS, < 3 metastatic sites, and no brain metastasis at diagnosis were associated with better OS.

Conclusion: In older patients with EGFR-mutated NSCLC and receive EGFR-TKI treatment, a good PS and <3 metastatic sites at diagnosis were associated with a longer PFS and OS. In addition, afatinib as first-line treatment was associated with a longer PFS whereas a relatively younger age and no brain metastasis at diagnosis were associated with better OS.

Keywords: epidermal growth factor receptor tyrosine kinase inhibitor; non-small-cell lung cancer; older adults; performance status.