Recent Management of Patients with Advanced Epidermal Growth Factor Receptor Mutation Non-small Cell Lung Cancer: Role of Afatinib and Lesson Learned for Developing Countries
Abstract: Lung cancer is a
devastating disease with a high incidence, mortality and morbidity rate,
especially in developing countries. Conventional treatment with cytotoxic
chemotherapy has some limitations attributed to chemoresistance and toxicity.
Recent advances have shown that first generation Tyrosine Kinase Inhibitor
(TKI), Gefitinib and Erlotinib, and the newest available second generation
Tyrosine Kinase Inhibitor (TKI), Afatinib, have the potential to be an option
in the management of patients with epidermal growth factor receptor/ EGFR
mutation positive advanced/ metastatic non-small cell lung cancer. Afatinib
works by binding to EGFR irreversibly, thus inactivating the tyrosine kinase
receptor. Some studies demostrated that Afatinib first-line may result in
longer progression free survival (PFS) and better disease control, and as an
alternative for patients who intolerance to Gefitinib or Erlotinib. In
Indonesia, the era of National Health Insurance has been implemented and
National Health Insurance has covered treatment for cancer, including first
generation TKIs, Gefitinib dan erlotinib, for patients with EGFR mutation
positive advanced/ metastatic non-small cell lung cancer at Cipto Mangunkusumo
National Hospital. Afatinib, as one of the newest available second generation
TKI, may be given free of charge too as an alternative if the National Health
Insurance will be covered in the future. Further research is needed to know the
efficacy and adverse effects that may occur in patients from developing countries.
Keywords: advanced/metastatic
non small cell lung cancer; EGFR mutation; afatinib
Author: Zulkifli Amin, Vito
Filbert Jayalie, Wulyo Rajabto
Journal Code: jpkedokterangg170320
