Asian patients in LUX-Lung 3 and 7
Data from LUX-Lung 3 (72% Asian population) and LUX-Lung 7 (57% Asian population) indicate that efficacy of afatinib* in Asian patients with non-small cell lung cancer (NSCLC) is in line with that seen in other study populations, with epidermal growth factor receptor (EGFR) mutation status being a key predictor of efficacy, rather than ethnicity.1,2 For instance, the hazard ratio (HR) for progression-free survival (PFS) in LUX-Lung 7 was 0.72 for non-Asian patients and 0.76 for the Asian population.2
Japanese patients in LUX-Lung 3
A subgroup analysis of Japanese patients who participated in LUX-Lung 3 showed a significant increase in PFS with afatinib compared with cisplatin/pemetrexed in all Japanese patients, as well as in patients with common EGFR mutations. Overall survival (OS) was significantly longer with afatinib than with chemotherapy in patients with del19 mutations (46.9 vs 31.5 months), but did not differ significantly between treatment arms in patients with L858R mutations.3
PFS outcomes for Japanese patients in LUX-Lung 3
CI, confidence interval; Cis, cisplatin; HR, hazard ratio; Pem, pemetrexed; PFS, progression-free survival.
OS outcomes for Japanese patients with del19 mutations in LUX-Lung 3
CI, confidence interval; Cis, cisplatin; HR, hazard ratio; Pem, pemetrexed; OS, overall survival.
Chinese patients in LUX-Lung 6
The LUX-Lung 6 Phase III trial was conducted in Asian countries; 90% of randomised patients were of Chinese ethnicity.
A post-hoc analysis of the Chinese patient subgroupt demonstrated that, overall, afatinib significantly increased PFS compared with gemcitabine/cisplatin: median 11.0 vs 5.6 months; HR=0.30; 95% confidence interval (CI): 0.21–0.43; p<0.0001. The objective response rate (ORR) and disease control rate were (DCR) also significantly higher with afatinib than with gemcitabine/cisplatin in the overall population: ORR, 67% vs 24%, respectively; odds ratio=6.94; 95% CI: 4.05–11.88 (p<0.0001); DCR, 92% vs 77%, respectively; odds ratio=3.45; 95% CI: 1.77–6.71 (p=0.0003).4
Although there was no significant difference in OS between the treatment arms for the overall population (p=0.7765), in patients with EGFR Del19 mutations OS afatinib significantly improved OS compared with gemcitabine/cisplatin: median 31.6 vs 16.3 months, respectively; HR=0.61; 95% CI: 0.41–0.91 (p=0.0146).4 Afatinib also significantly increased PFS compared with gemcitabine/cisplatin in in patients with common (EGFR Del19 or L858R) mutations: median 11.0 vs 5.6 months; HR=0.26; 95% CI: 0.18–0.37; p<0.0001).4
There were no unexpected safety findings with afatinib in Chinese patients.4
Chinese patients with squamous NSCLC in LUX-Lung 8
A post-hoc subgroup analysis of data from 67 Chinese patients with advanced squamous NSCLC in LUX-Lung 8 confirmed that the efficacy, safety and tolerability of afatinib in this subgroup are in line with that seen in the overall study population.5 Trends favouring afatinib versus erlotinib in terms of PFS (median 2.8 vs 2.8 months; HR=0.70; 95% CI: 0.38–1.27), OS (median 10.8 vs 8.2 months; HR=0.69; 95% CI: 0.39–1.21), tumour control and improvements in patient-reported outcomes (PRO) were comparable to those in the overall study population.5
The long-term benefit of afatinib appeared more pronounced in the Chinese subgroup compared with the overall LUX-Lung 8 population. Four of the 36 Chinese patients (11%) treated with afatinib were long-term responders who received afatinib for ≥12 months, compared with 21/398 (5%) of the overall study population.5 At the data cut-off, three of the four Chinese long-term responders were still on treatment, while the fourth had disease progression.5
Asian results from an afatinib named patient use programme in patients who progressed following prior therapies
A subanalysis was performed in patients who had participated in the afatinib named patient use programme in Asian countries (N=2,242) and received a median of three lines of prior therapy.6 Response data were available from 431 patients; ORR was 24.4% in the overall population, 27.4% in patients with common EGFR mutations (n=230) and 28.1% in patients with uncommon EGFR mutations (n=32).6 Median TTF with afatinib was 7.6 months in 1,550 patients for whom data were available, 6.4 months in patients with common EGFR mutations (n=692), 8.4 months in patients with uncommon EGFR mutations (n=83) and 12.2 months in patients with HER2 mutations.6 The safety profile of afatinib in Asian patients was consistent with that in non-Asian patients.
Mok T, et al. J Thorac Oncol 2012;7(11, Suppl. 5):Abstract HO-003.
Park K, et al. Lancet Oncol 2016;17(5):577–89.
Kato T, et al. Cancer Sci 2015;106(9):1202–11.
Wu Y-L, et al. Oncotargets and Therapy 2018;11:8575–87.
Lu S, et al. Oncotargets and Therapy 2018;11:8565-73.
Chang G-C, et al. Poster presented at WCLC 2018 (Poster P1.01-11).
*Afatinib is approved in more than 80 markets, including the EU, Japan, Taiwan and Canada under the brand name GIOTRIF®, in the US under the brand name GILOTRIF® and in India under the brand name Xovoltib®; for the full list, please click here. Registration conditions differ internationally; please refer to locally approved prescribing information.
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