Is afatinib effective in non-small cell lung cancer that has spread?

This review looked at the effectiveness and safety of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor, afatinib (Gilotrif) in patients with non-small cell lung cancer (NSCLC) that has spread from its original site. 

Many NSCLC patients have a mutated (abnormal) EGFR gene, which can increase the production and spread of cancer cells. For these patients, first-line treatments include EGFR-tyrosine kinase inhibitors, such as afatinib. These block the activity of EGFR, which slows cancer cell production.

This EGFR mutation is more common in patients of Asian origin.

The current review examined the use of afatinib in patients with EGFR mutations. The reviewers looked at 8 different trials and compared the results of these to each other to make their recommendations.

Progression free survival is the time following treatment before the disease progresses. In one study of patients who had not received afatinib or similar drugs previously, the progression free survival rate was 11.1 months for patients taking afatinib compared with 6.9 months for those on another treatment.

In a second study, a longer overall survival (time from treatment until death from any cause) was 19% more likely for patients treated with afatinib compared to chemotherapy. 

In patients who had already received other EGFR-tyrosine kinase inhibitors, the results were not as clear. For example, in one study, patients on afatinib survived for 5.8 months on average compared to 4.6 months for the group taking a placebo (substance with no effect on the body). Progression-free survival in this study was 3.3 months for patients treated with afatinib and 1.1 months for those treated with placebo.

In studies combining afatinib with chemotherapy, progression-free survival increased by 40% compared to chemotherapy alone. However, overall survival times were the same for both groups, and side effects were more serious when both treatments were used together.

Side effects associated with afatinib were mainly diarrhea, rash and acne. Many patients found the side effects worse with afatinib compared with a similar drug, erlotinib. 

The reviewers concluded that afatinib is useful for patients with an EGFR mutation and NSCLC that has spread from its original site. They found afatinib was especially useful when compared with chemotherapy. 

Discuss afatinib for treating your NSCLC with your doctor.