Afatinib in locally advanced/metastatic NSCLC harboring common EGFR mutations, after chemotherapy: a Phase IV study.

AIM: The current study evaluated the efficacy and tolerability of second-line afatinib in patients with EGFR mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC) following chemotherapy. PATIENTS & METHODS: In this open-label, single-arm Phase IV study, patients with EGFRm+ (Del19/L858R) NSCLC who had progressed following platinum-based chemotherapy received afatinib (starting dose 40 mg/day). The primary end point was confirmed objective response. RESULTS: 60 patients received afatinib for a median duration of 11.5 months. 50% of patients had a confirmed objective response, of median duration 13.8 months. Median progression-free survival was 10.9 months. The most common treatment-related adverse events were diarrhea (72%), rash (28%) and paronychia (23%). CONCLUSION: Our data support the use of afatinib (40 mg/day) as an effective and well-tolerated second-line treatment in EGFRm+ NSCLC.

A very rare presentation of lung cancer: Metastases to the distal phalanx of index-case report.

RATIONALE: Acrometastases of the hand are an unusual sign of lung cancer onset and may often be mistaken for other benign disorders, thus delaying diagnosis and treatment. PATIENT CONCERNS: A 58-year-old man presented at the Rheumatology Clinic with a lump in the distal phalanx of the right index finger associated with intense pain, swelling, rib pain, and hemoptysis. DIAGNOSES: Given the clinical manifestations, an x-ray of the right hand was performed, and it revealed an osteolytic lesion in the distal phalanx of the right index finger. The subsequent CT of the thorax and abdomen showed a lung tumor, osteolytic lesions in the ribs, sternum, and the thoracic spine. INTERVENTIONS: Amputation of the phalanx was decided on account of intense pain refractory to NSAIDs and opioids. Pathology assessment established the diagnosis of bone metastases secondary to lung adenocarcinoma. The patient underwent 6 cycles of first-line palliative chemotherapy with cisplatin and gemcitabine with partial response according to the RECIST 1.1. criteria. EGFR and ALK testing were not available at the time. A year later, the patient presented with progressive disease, which lead to 6 more cycles of chemotherapy with docetaxel. The disease progressed during chemotherapy and the patient was switched to erlotinib. OUTCOMES: After 7 months of anti-EGFR treatment, the patient passed away due to disease progression, thus having an overall survival of 25 months. LESSONS: On rare occasions, acrometastases of the hand may be the first manifestation of a lung cancer and, as such, they must be taken into consideration in the differential diagnosis of rheumatologic disorders. They are a poor prognosis marker, but some cases like this one can have a better survival than reported in the literature, most likely due to that particular cancer's biology.

[Age-related prognostic factors and treatment results for advanced non-small cell lung cancer (NSCLC)]. / Factorii prognostici si evolutia pacientilor vârstnici cu cancere bronho-pulmonare non-microcelulare avansate.

UNLABELLED: There is much debate whether the choice of management for elderly patients with locally advanced, inoperable NSCLC with good performance status (PS) should be made entirely on terms of age. MATERIAL AND METHOD: We compared the results of chemotherapy (CT), radiotherapy (RT) and chemoradiotherapy (CT-RT) of the elderly with those of younger patients, and studied predictive factors for survival in these age groups. 231 patients with advanced NSCLC were included in this study, being grouped by age: > 65 years (148p, 64.1%) versus < 65 years old (83p, 35.9%). Univariate analysis and Cox regression models were used to assess significance of variables for prediction of survival. RESULTS: Mean overall survival (OS) for the whole group was 11.48 months (median 9.0 months); no significant difference in median OS was found between elderly and younger patients (11.55 vs. 11.65 months, p = 0.537). Univariate analysis revealed significant survival benefits in both age groups as per weight loss < 5%, absence of comorbidities, earlier clinical stage, high initial Hb levels, longer time-to-progression (TTP) and good PS. Treatment type had different survival impact on the age groups; best median survival in patients > 65 years (14.0 months) was obtained by CT alone, while patients < 65 years benefited more (13.35 months) from sequential CT-RT. Logistic regression model identified 5 variables to be significant for survival in all patients: PS, extent of disease, hemoglobin (Hb), TTP and age. When applied to the elderly group, only 4 variables had predictive value: extent of disease, Hb, TTP and presence of comorbidities. Treatment toxicity did not differ significantly between age subsets, except for renal toxicity, which was greater in elderly patients. Age should not be a choice-limiting item for the treatment of advanced NSCLC. CONCLUSION: An active therapeutic approach, such as chemotherapy, can be feasible, effective and well tolerated in selected elderly NSCLC patients with a good PS and no associated comorbidities.