Varying degrees of toxicity risks between different epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) can help inform treatment decisions for individual patients with non-small cell lung cancer (NSCLC), according to a study published in the Journal of Thoracic Oncology.
-----
Related Content
Consensus statement on EGFR-positive NSCLC released
TKI Drug Improves Survival in Metastatic Kidney Cancer
-----
TKIs are considered standard of care for treatment of advanced EGFR-mutated NSCLC. Some of the common TKIs used for treatment include gefitinib, erlotinib, and afatinib. Determining the differences in toxicity profiles and risks between these EGFR-TKIs is essential for treatment decisions on a patient-to-patient basis.
Research led by Pei Ni Ding, MD, Department of Medical Oncology, Liverpool Hospital (Sydney, Australia), examined the relative risks of toxic death, grade 3-4 adverse events, and treatment discontinuation due to adverse events for patients treated with gefitinib, erlotinib, and afatinib. The study consisted of a meta-analysis of 16 randomized trials that compared EGFR-TKI with chemotherapy alone or placebo. Researchers extracted data from the EGFR-TKI group (2535 patients) for indirect comparisons to estimate toxicity risks. Results of the study were presented in part at the 15th World Conference on Lung Cancer (October 27-30, 2013).
Results of the study found toxic deaths (1.7%) to be rare for patients, with pneumonitis being the most common cause. There were no significant differences in toxic deaths between the three EGFR-TKIs.
A total of 40% of patients experienced grade 3-4 adverse events, with diarrhea (53.3%) and rash (66.5%) being the most common events. The risk of grade 3-4 adverse events was lower for gefitinib (29.1%) than erlotinib (54.1%) and afatinib (42.1%). Risks of diarrhea and rash were higher for afatinib (91.7% and 84.8%, respectively) than for gefitinib (44.4% and 62.0%) or erlotinib (42.4% and 62.0%). Risk of elevated liver enzymes was higher for gefitinib (61.7%) than for erlotinib (17.8%) or afatinib (20.1%).
Treatment discontinuation due to adverse events occurred in only 7.7% of patients, with no significant differences between the three EGFR-TKIs.
Researchers concluded that all three EGFR-TKIs are well tolerated among patients with NSCLC. Varying toxicity risks between different EGFR-TKIs is important to consider when informing personalized treatment decisions.
