Background
Methods
Study population
Statistical analysis
Results
Clinico-pathologic characteristics
Characteristic | No. | % |
---|---|---|
Sex | ||
Male | 64 | 51.2 |
Female | 61 | 48.8 |
Age at diagnosis, years | ||
Median | 62 | |
Range | 26–86 | |
Ethnicity | ||
Chinese | 100 | 80.0 |
Malay | 14 | 11.2 |
Indian | 3 | 2.4 |
Others | 8 | 6.4 |
Smoking status | ||
Never | 95 | 76.0 |
Former | 17 | 13.6 |
Current | 13 | 10.4 |
Histotype – NSCLC | ||
Adenocarcinoma | 121 | 96.8 |
Adenosquamous carcinoma | 1 | 0.8 |
NOS | 3 | 2.4 |
EGFR mutation type | ||
Exon 19 deletion[a] | 87 | 69.6 |
Exon 21 L858R | 27 | 21.6 |
Others[b] | 11 | 8.8 |
Brain metastases at baseline | ||
No | 82 | 65.6 |
Yes | 42 | 33.6 |
Unknown | 1 | 0.8 |
Starting dose of afatinib once daily (OD) | ||
40 mg | 62 | 49.6 |
0 mg | 61 | 48.8 |
0 mg | 1 | 0.8 |
Unknown | 1 | 0.8 |
Factors influencing outcomes to afatinib
No. of events/ patients | Median PFS, months (95% CI) | Log-rank p-value | Hazard ratio (95% CI) | Cox model p-value | |
---|---|---|---|---|---|
Total | 60 / 120 | 11.9 (10.3, 19.3) | NA | NA | NA |
Sex | |||||
Male | 35 / 62 | 13.3 (9.0, 20.1) | 0.344 | 1 | 0.343 |
Female | 25 / 58 | 11.9 (10.3, 25.7) | 0.78 (0.47, 1.31) | ||
Age at diagnosis, years | |||||
< 65 | 45 / 86 | 11.9 (9.7, 19.3) | 0.791 | 1 | 0.790 |
≥ 65 | 15 / 34 | 11.7 (5.3, UD) | 0.92 (0.51, 1.66) | ||
Smoking history | |||||
Never | 42 / 91 | 14.5 (10.7, 22.1) | 0.017 | 1 | 0.025 |
Former / Current | 18 / 29 | 7.9 (3.5, 17.4) | 1.94 (1.12, 3.38) | ||
EGFR mutation type | |||||
Exon 19 deletion | 40 / 83 | 15.0 (10.9, 22.1) | < 0.001 | 1 | 0.008 |
L858R | 12 / 27 | 11.2 (6.5, UD) | 1.19 (0.62, 2.28) | ||
Others | 6 / 8 | 4.5 (1.7, UD) | 5.51 (2.23, 13.64) | ||
Brain metastasis at start of afatinib | |||||
No | 40 / 80 | 15.0 (10.9, 20.6) | 0.140 | 1 | 0.153 |
Yes | 20 / 40 | 7.9 (5.1, 13.3) | 1.50 (0.87, 2.57)a | ||
Starting doseb | |||||
30 mg | 23 / 58 | 10.7 (6.5, UD) | 0.105 | 1 | 0.113 |
40 mg | 37 / 61 | 15.0 (10.8, 20.6) | 0.63 (0.36, 1.11) | ||
Amongst patients with no brain metastasis: | |||||
Starting doseb | |||||
30 mg | 10 / 35 | UD | 0.897 | 1 | 0.898 |
40 mg | 30 / 44 | 15.0 (10.8, 22.1) | 0.95 (0.44, 2.04) | ||
Amongst patients with brain metastasis: | |||||
Starting dose | |||||
30 mg | 13 / 23 | 5.3 (3.1, 10.7) | 0.040 | 1 | 0.041 |
40 mg | 7 / 17 | 13.3 (6.5, UD) | 0.39 (0.15, 0.99) | ||
Amongst patients on 30 mg starting dose: | |||||
Brain metastasis | |||||
No | 10 / 35 | UD | 0.007 | 1 | 0.010 |
Yes | 13 / 23 | 5.3 (3.1, 10.7) | 2.96 (1.29, 6.79) | ||
Amongst patients on 40 mg starting dose: | |||||
Brain metastasis | |||||
No | 30 / 44 | 15.0 (10.8, 22.1) | 0.567 | 1 | 0.558 |
Yes | 7 / 17 | 13.3 (6.5, UD) | 0.79 (0.34, 1.80)a |
Characteristics of patients with brain metastasis initiated on 30 mg vs. 40 mg
Characteristic | Starting dose 30 mg, n (%) | Starting dose 40 mg, n (%) | p-value |
---|---|---|---|
Age at diagnosis, years | |||
Median (range) | 62 (47–78) | 58 (26–76) | 0.299 |
< 65 | 15 (60.0) | 12 (70.6) | 0.482 |
≥ 65 | 10 (40.0) | 5 (29.4) | |
Sex | |||
Female | 16 (64.0) | 6 (35.3) | 0.067 |
Male | 9 (36.0) | 11 (64.7) | |
ECOG at start of afatinib | |||
0–1 | 20 (80.0) | 14 (82.4) | 1.000 |
2–3 | 5 (20.0) | 3 (17.6) | |
Smoking history | |||
Never | 18 (72.0) | 13 (76.5) | 1.000 |
Former/Current | 7 (28.0) | 4 (23.5) | |
Brain RT pre-afatinib | |||
Yes | 12 (48.0) | 14 (82.4) | 0.024 |
No | 13 (52.0) | 3 (17.6) | |
Brain RT post-afatinib | |||
Yes | 4 (16.0) | 3 (17.6) | 1.000 |
No | 21 (84.0) | 14 (82.4) | |
EGFR mutation type | |||
Exon 19 deletion | 15 (62.5) | 9 (52.9) | 0.019 |
Exon 20 insertion | 1 (4.2) | 0 | |
Exon 21 L858R | 3 (12.5) | 8 (47.1) | |
Double mutation | 5 (20.8) | 0 | |
Unknown | 1 | 0 | |
Site of progressiona | |||
CNS | 7 (63.6) | 3 (30.0) | 0.198 |
Systemic | 4 (36.4) | 7 (70.0) | |
No PD / unknown: | |||
Still on afatinib | 5 | 2 | |
Went on 2nd line | 3 | 4 | |
No scans / no PD recorded | 4 | 1 | |
FU at other hospital | 2 | 0 | |
Afatinib dose at PD, mg | |||
20 | 2 (18.2) | 1 (10.0) | 0.270 |
30 | 9 (81.8) | 6 (60.0) | |
40 | 0 | 3 (30.0) | |
No PD / unknown | 14 | 7 |
Multivariable analysis | Hazard ratio (95% CI) | p-value |
---|---|---|
Brain RT pre-afatinib | ||
No | 1 | |
Yes | 2.79 (0.93, 8.35) | 0.062 |
Starting dose | ||
30 mg | 1 | |
40 mg | 0.22 (0.07, 0.67) | 0.006 |
Influence of starting dose on outcomes in patients with brain metastases
No. of events / patients | Hazard ratio (95% CI) | p-value | |
---|---|---|---|
Brain metastasis; starting dose | 60 / 119 | ||
Brain mets; 40 mg | 1 | ||
Brain mets; 30 mg | 3.73 (1.45, 9.61) | 0.006 | |
No brain mets; 40 mg | 1.29 (0.57, 2.96) | 0.542 | |
No brain mets; 30 mg | 1.21 (0.45, 3.23) | 0.711 | |
p-value of brain mets-starting dose interaction:
|
0.020
| ||
Amongst never smokers with exon 19 deletion or L858R mutation: | |||
Brain metastasis; starting dose | 37 / 84 | ||
Brain mets; 40 mg | 1 | ||
Brain mets; 30 mg | 5.23 (1.42, 19.28) | 0.013 | |
No brain mets; 40 mg | 1.67 (0.57, 4.87) | 0.345 | |
No brain mets; 30 mg | 1.10 (0.29, 4.20) | 0.884 | |
p-value of brain mets-starting dose interaction:
|
0.011
|