Cancer Treatment Today

The evidence for the use of the EGFR agent gelfitinib after failure of other EGFR mutation directed agents is scant. Ueda et al reported a patient described a patient with EGFR mutationpositive lung adenocarcinoma who developed severe hepatotoxicity during treatment first with gefitinib and then with erlotinib, but who was subsequently able to continue treatment with afatinib for at least 44 weeks with no evidence of hepatotoxicity or disease progression. Yamaguchi identified afatinib was identified as one of the therapeutic options after 1st TKI failure in the patients with advanced NSCLC harboring EGFR mutation when the time of treatment by prior 1st TKI is more than 10 months. There is speculation based on case reports and series that it may be effective, but no prospective study evidence.

Ueda, H., Hayashi, H., Kudo, K. et al. Successful treatment with afatinib after gefitinib- and erlotinib-induced hepatotoxicity. Invest New Drugs 34, 797799 (2016). https://doi.org/10.1007/s10637-016-0384-1
O. Yamaguchi et al, Re-challenge of afatinib after 1st generation EGFR-TKI failure in patients with previously treated non-small cell lung cancer harboring EGFR mutation. Cancer Chemother Pharmacol . 2019 May;83(5):817-825
MOTOHIRO TAMIYA, AKIHIRO TAMIYA, HIDEKAZU SUZUKI, KAZUNORI MORIIZUMI, KENJI NAKAHAMA, YOSHIHIKO TANIGUCHI, KEI KUNIMASA, MADOKA KIMURA, TAKAKO INOUE, HANAKO KUHARA, KAZUMI NISHINO, TOMONORI HIRASHIMA, SHINJI ATAGI, FUMIO IMAMURA and TORU KUMAGAI Which Is Better EGFR-TKI Followed by Osimertinib: Afatinib or Gefitinib/Erlotinib? Anticancer Research July 2019, 39 (7) 3923-3929;