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Background: Afatinib 30 mg has been proved to be with comparable efficacy but more tolerable than the dose of 40 mg for Asian patients with non-small cell lung cancer (NSCLC). This study aimed to investigate the clinical outcomes of afatinib at 30 mg/d in the treatment of advanced lung adenocarcinomas (LAD) with common and uncommon epidermal growth factor receptor ( EGFR ) mutations., Methods: EGFR -mutated advanced LAD patients receiving afatinib (30 mg/d) from January 2017 to November 2021 were retrospectively included. EGFR status was classified into three subtypes, namely common mutations including exon 19 deletions (19del) and exon 21 L858R (21L858R), uncommon mutations including G719X, L861Q, S768I, and complex mutations, and separately exon 20 insertions (20ins). Progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) and adverse events (AEs) were analyzed during regular follow-up., Results: The overall median PFS of totally 58 included patients was 9.83 [95% confidence index (CI): 5.76-13.91] months. The number of patients with common, uncommon, and 20ins mutations was 32 (55.2%), 19 (32.8%) and 7 (12.1%), respectively. Baseline characteristics did not differ significantly among the three subtypes. The corresponding median PFS was 13.97 (12.06-15.89), 8.48 (0.32-16.64), and 3.78 (1.93-5.64) months, respectively (P=0.002). In the first-line setting, patients with common and uncommon mutations had a significantly longer PFS compared to those with 20ins [14.53 (13.53-15.53) vs. 10.39 (4.87-15.91) vs. 2.37 (0.00-5.11) months, P<0.001]. The first-line ORR showed significant differences among the three subtypes (60% vs. 80% vs. 0.0%, P=0.023). All-grade AEs occurred in 22 patients (37.9%). AEs ≥ grade 3 mainly included diarrhea (8.6%), and none of the patients discontinued treatment due to severe AEs., Conclusions: Afatinib at 30 mg/d is associated with a favorable efficacy and tolerability in the treatment of advanced LAD with common and major uncommon EGFR mutations except 20ins. Further large-scale prospective studies are warranted to confirm our findings., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-507/coif). The authors have no conflicts of interest to declare., (2022 Journal of Thoracic Disease. All rights reserved.)

Objective: To explore the relevance of carcinoembryonic antigen (CEA) level and efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced non-small cell lung cancer (NSCLC) harboring EGFR mutations., Methods: Between September 2010 and December 2013, 170 NSCLC patients harboring EGFR mutations receiving EGFR-TKI treatment at pulmonary medicine department of Shanghai Chest hospital were retrospectively screened. They were screened for clinical characteristics, efficacy of EGFR-TKI, and tumor markers (CEA/cytokerantin-19-fragment CYFRA21-1) at an initial diagnosis. The cutoff value for CEA was 5 µg/L., Results: The overall objective response rate (ORR) was 37.6% and disease control rate (DCR) 90.0%. Those with high CEA levels (>5 µg/L) had better DCR (94.3% vs 80.4%, P = 0.022). Univariate analysis showed that patients with high CEA levels ( ≥ 20 µg/L) had significantly longer progression-free survival (PFS) than those with low CEA level (HR = 1.444, 95%CI: 1.036-2.014, P = 0.030). HR value increased with rising CEA levels. No significant difference in PFS existed between high-CYFRA21-1 and normal-CYFRA21-1 groups (HR = 1.167, 95%CI: 0.840-1.622, P = 0.357). Close follow-ups were conducted for 51 patients on EGFR-TKI treatment. And their CEA levels was tested within one month after treatment. The patients in descending type group had longer PFS than other two types (HR = 7.344, 95%CI: 2.903-18.578, P < 0.001)., Conclusions: CEA level has a close correlation with the efficacy of EGFR-TKI treatment. And a high CEA level may be a predictive marker for better response and longer PFS in advanced NSCLC.

Background: At present the proportion of lung adenocarcinomas in NSCLC is higher than before. Thus, the study on prognosis of lung adenocarcinoma is extremely important. The predictive value of epidermal growth factor receptor (EGFR) mutations for prognosis in patients with resected lung adenocarcinomas has not be reported in China. The aim of this study is to analyze the association between the EGFR mutations and the outcomes of patients with resected lung adenocarcinomas., Methods: Total of 301 patients with stage Ia-IIIa resected lung adenocarcinomas whose survival had been identified were retrospectively analyzed. Their EGFR mutations were detected by real-time quantitative PCR and DNA sequencing technology together., Results: The proportion of EGFR mutation was 52.5% (158/301). The 2-year (disease-free survival, DFS) of EGFR-mutant group and wild-type EGFR group was 76.8%, 83.0%; 5-year overall survival (OS) of them was 67.7%, 65.7%. There was no significant difference for two groups (P = 0.252, P = 0.715). Further analysis for subgroups shows that the 2-year DFS, 5-year OS of mutant group and wild-type group in stage I-II was similar. For the patients with stage IIIa, the median DFS, 2-year DFS in mutant group was 12.2 months, 21.1%, lower than the 22.2 months, 42.1% in wild-type group. But there was no significant difference for both groups (P = 0.584, P = 0.295). The median OS, 5-year OS was 34.0 months, 30.8% in mutant group, while 38.7 months, 22.9% in wild-type group. There was no significant difference for both groups (P = 0.907, P = 0.444)., Conclusions: EGFR-mutant group with resected lung adenocarcinomas has a tendency of lower DFS than the wild-type EGFR group only in stage IIIa, but there was no significant difference for both groups. The EGFR mutation status was not associated with disease-free survival or overall survival in resected lung adenocarcinomas.