The Time to Progression in Lung Adenocarcinoma Patients Receiving First- and Second-Generation EGFR-TKI in Indonesia

Introduction: Targeted therapy, particularly EGFR TKI, is the first-line treatment for non-small cell lung cancer (NSCLC). However, drug resistance has grown in the last few decades. Few studies tried to compare the time of progression among NSCLC and showed inconsistent findings. This study compares the progression time of lung cancer patients treated with first- and second-generation EGFR-TKI.

Methods: This cross-sectional study included 1.008 participants diagnosed with lung adenocarcinoma from 11 Indonesian Respiratory Centers based on cytology and histological results. Every three months, the response to treatment was assessed using the RECIST criteria in 1.1. Significant differences in the clinical features of the three TKI treatment groups were identified using logistic regression analysis, the median time to disease progression was estimated using the Kaplan-Meier technique, and independent prognostic factors related to the time to progression were assessed using Cox proportional hazards regression.

Results: This study examined 505 patients, the majority of whom were female (50.9%), never smoked (59.8%), diagnosed at an advanced stage (99.2%), and had an ECOG 0-1 (83.2%). Approximately 98.1% of patients were treated with afatinib (14.8%), erlotinib (18.6%), and gefitinib (66.1%) due to common mutations. The groups did not differ significantly (p > 0.05), and the median overall survival rate was 9 months. The time to LUAD progression in lung cancer was significantly impacted by poor performance (p = 0.001).

Conclusion: EGFR-TKI treatment can only prolong the time to progression of lung adenocarcinoma by up to nine months, and the performance scale when receiving the EGFR TKI significantly affects the prognosis.