Symptom and Quality of Life Improvement in LUX-Lung 6: An Open-Label Phase III Study of Afatinib Versus Cisplatin/Gemcitabine in Asian Patients With EGFR Mutation-Positive Advanced Non-small-cell Lung Cancer.
BACKGROUND
In the phase III, LUX-Lung 6 trial, afatinib prolonged progression-free survival (PFS) versus cisplatin/gemcitabine in Asian patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). This article provides detailed assessments of patient-reported outcomes (PROs), a LUX-Lung 6 secondary end point, and explores the relationship between PFS and health-related quality of life (QoL) in these patients.


METHODS
Patients (n = 364) were randomized (2:1) to oral afatinib (40 mg/day) or up to six cycles of cisplatin/gemcitabine (21-day cycle; cisplatin 75 mg/m(2) [d1]; gemcitabine 1000 mg/m(2) [d1,8]). QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its lung cancer-specific module. The relationship between PFS (investigator assessment and independent review) and QoL was evaluated using analysis of covariance and a longitudinal model.


RESULTS
More patients treated with afatinib versus cisplatin/gemcitabine showed improvements in global health status/QoL (p < 0.0001) and physical (p < 0.0001), role (p = 0.013), and social (p < 0.001) functioning scales. Delayed symptom deterioration and better QoL over time was also observed with afatinib. QoL measured before tumor assessment was considerably poorer for patients with progression than those without progression, with significant differences in mean scores at multiple assessment time points. Results from the longitudinal analysis consistently demonstrated a significant negative impact of progression on QoL (p < 0.0001).


CONCLUSIONS
Afatinib improved PFS and PROs versus chemotherapy in EGFR mutation-positive NSCLC patients. Progression was associated with statistically significant worsening in QoL measured before tumor assessment, underscoring the value of PFS as a clinically relevant end point.
*Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; †Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China; ‡Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China; §Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China; ‖Department of Internal Medicine, Jiangsu Provincial Tumor Hospital, Nanjing, Jiangsu, China; ¶Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China; #Yunnan Tumor Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, Yunnan Province, China; **Cancer Center, First Hospital of Jilin University, Changchun, China; ††Department of Oncology Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; ‡‡Oncology Department, Lin Yi Tumor Hospital, Linyi, Shandong Province, China; §§Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea; ‖‖Medical Statistics Department, Keele University, Keele, United Kingdom; ¶¶Boehringer Ingelheim International Trading, Shanghai, China; and ##Boehringer Ingelheim GmbH, Ingelheim, Germany.
Sarayut L
SL
Geater
Chong-Rui
CR
Xu
Caicun
C
Zhou
Cheng-Ping
CP
Hu
Jifeng
J
Feng
Shun
S
Lu
Yunchao
Y
Huang
Wei
W
Li
Mei
M
Hou
Jian Hua
JH
Shi
Kye Young
KY
Lee
Michael
M
Palmer
Yang
Y
Shi
Juliane
J
Lungershausen
Yi-Long
YL
Wu
D000328:Adult; D000077716:Afatinib; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D044466:Asian People / Q000235:genetics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011788:Quality of Life; D011799:Quinazolines / Q000627:therapeutic use*; D016896:Treatment Outcome; D000093542:Gemcitabine
D011799:Quinazolines; D003841:Deoxycytidine; D000077716:Afatinib; C512478:EGFR protein, human; D066246:ErbB Receptors; D002945:Cisplatin; D000093542:Gemcitabine