Volume 21, Issue 3 pp. 281-289
ORIGINAL ARTICLE

The Effectiveness of Afatinib as First-Line Treatment in Vietnamese Patients With EGFR-Mutant Non–Small Cell Lung Cancer and Brain Metastases

Thai Van Pham

Thai Van Pham

Department of Oncology, Hanoi Medical University, Hanoi, Vietnam

The Nuclear Medicine and Oncology center, Bach Mai Hospital, Hanoi, Vietnam

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Thanh Ha Vu

Corresponding Author

Thanh Ha Vu

Department of Oncology, Hanoi Medical University, Hanoi, Vietnam

Department of Medical Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam

Correspondence: Thanh Ha Vu ([email protected])

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Hoa Thai Thi Nguyen

Hoa Thai Thi Nguyen

Department of Medical Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam

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Phuong Cam Pham

Phuong Cam Pham

The Nuclear Medicine and Oncology center, Bach Mai Hospital, Hanoi, Vietnam

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Anh Tu Do

Anh Tu Do

Department of Medical Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam

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Tuan Khoi Nguyen

Tuan Khoi Nguyen

Department of Medical Oncology, Ho Chi Minh City Oncology Hospital, Ho Chi Minh, Vietnam

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Thi Anh Thu Hoang

Thi Anh Thu Hoang

Department of Medical Oncology, Ho Chi Minh City Oncology Hospital, Ho Chi Minh, Vietnam

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Tuan Anh Le

Tuan Anh Le

Oncology center, Cho Ray Hospital, Ho Chi Minh, Vietnam

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Dinh Thy Hao Vuong

Dinh Thy Hao Vuong

Oncology center, Cho Ray Hospital, Ho Chi Minh, Vietnam

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Dac Nhan Tam Nguyen

Dac Nhan Tam Nguyen

Department of Oncology, Thong Nhat Hospital, Ho Chi Minh, Vietnam

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Van Khiem Dang

Van Khiem Dang

Department of Oncology, National Lung Hospital, Hanoi, Vietnam

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Thi Oanh Nguyen

Thi Oanh Nguyen

Department of Oncology, National Lung Hospital, Hanoi, Vietnam

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Van Luan Pham

Van Luan Pham

Department of Respiratory Medicine, 108 Military Central Hospital, Hanoi, Vietnam

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Minh Hai Nguyen

Minh Hai Nguyen

Department of Respiratory Medicine, 108 Military Central Hospital, Hanoi, Vietnam

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Thi Huyen Trang Vo

Thi Huyen Trang Vo

The Nuclear Medicine and Oncology center, Bach Mai Hospital, Hanoi, Vietnam

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Khoa Trong Mai

Khoa Trong Mai

The Nuclear Medicine and Oncology center, Bach Mai Hospital, Hanoi, Vietnam

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Hung Kien Do

Hung Kien Do

Department of Medical Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam

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Thi Thuy Hang Nguyen

Thi Thuy Hang Nguyen

Department of Medical Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam

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Le Huy Trinh

Le Huy Trinh

Department of Oncology, Hanoi Medical University, Hanoi, Vietnam

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Hoang Gia Nguyen

Hoang Gia Nguyen

Department of Medical Oncology, Hanoi Oncology Hospital, Hanoi, Vietnam

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Cong Minh Truong

Cong Minh Truong

Department of Medical Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam

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Tran Minh Chau Pham

Tran Minh Chau Pham

Department of Medical Oncology, Ho Chi Minh City Oncology Hospital, Ho Chi Minh, Vietnam

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First published: 18 December 2024
Citations: 1

Funding: The authors received no specific funding for this work.

ABSTRACT

Introduction

The role of afatinib in the first-line treatment of EGFR-mutant advanced non–small cell lung cancer (NSCLC) patients has been proven through clinical trials and real-world studies. However, additional data on the effectiveness of afatinib in patients with brain metastases are lacking.

Methods

EGFR-mutant NSCLC patients with brain metastases were retrospectively reviewed across nine cancer centers in Vietnam from April 1, 2018 to June 1, 2022. The primary endpoints included central nervous system progression-free survival (CNS-PFS) and overall survival (OS). The secondary endpoints were the objective response rate (ORR) and CNS-ORR.

Results

Among 87 enrolled patients, 21.8%, 17.2%, and 60.9% received whole-brain radiation, gamma knife, and no locoregional therapy, respectively. With a median follow-up of 32.2 months for CNS-PFS and 35.3 months for OS, the median CNS-PFS and OS were 17.9 and 29.9 months, respectively. In multivariate analysis, patients receiving whole-brain radiation had significantly shorter CNS-PFS than those untreated with local therapy (16.1 vs. 22.6 months, p = 0.019), but not translating to an inferior OS. Furthermore, both the CNS-PFS and OS of patients with uncommon mutations were significantly worse than those of patients with Del19 (11.3 vs. 24.2 months, p = 0.013 and 17.7 vs. 34.0 months, p = 0.003, respectively). Univariate and multivariate analyses showed that a lower afatinib starting dose did not significantly affect CNS-PFS or OS. The CNS-ORR and ORR were 77.4% and 71.3%, respectively.

Conclusion

In our real-world study, afatinib showed encouraging effectiveness in Vietnamese patients with EGFR-mutant NSCLC and brain metastases at baseline.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The delinked and anonymized datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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