Noni Novisari Soeroso, Elisna Syahruddin, Chaliza Soliha, Laksmi Wulandari, Ana Rima Setijadi, Sabrina Ermayanti, Suryanti Dwi Pratiwi, Andreas Infianto, Novita Andayani, Sri Melati Munir, Avissena Dutha Pratama, Ida Ayu Jasminarti Dwi Kusumawardani, Haryati Haryati, Natalie Duyan, Muhammad Alfin Hanif, Darren Wan-Teck Lim
Introduction: Afatinib, a second-generation EGFR tyrosine kinase inhibitor (TKI), has demonstrated clinical benefit in EGFR-mutant non-small cell lung cancer (NSCLC) through clinical trials. However, real-world data, particularly in Southeast Asian populations, remain limited. This study aimed to evaluate the real-world progression-free survival (PFS) of Indonesian patients with EGFR-mutant advanced lung adenocarcinoma treated with first-line afatinib. Methods: A retrospective cohort study was conducted using data from 1008 EGFR-positive NSCLC patients screened between 2019 and 2023 across 14 Indonesian centers. Of these, 215 received afatinib, and 105 patients met eligibility criteria. Clinical and demographic data, including EGFR mutation types and ECOG performance status, were collected. Kaplan-Meier and Cox regression analyses were used to assess PFS and associated factors. Results: The median age was 59 years; 54.3 % were female and 65.7 % never-smokers. Exon 19 deletion was the most common mutation (57.1 %), followed by L858R (29.5 %). Median PFS was 12.0 months. ECOG performance status significantly influenced PFS: patients with ECOG 0–1 had a median PFS of 13.0 months versus 8.0 months for ECOG ≥2 (HR = 0.44; p = 0.001). Other variables, including smoking status, stage, and brain metastases, were not significantly associated with PFS. Mutation subtype analysis revealed non-significant trends. Conclusion: ECOG performance status is a significant prognostic factor for PFS in patients treated with first-line afatinib. These real-world findings support its continued use and highlight the need for broader multicenter studies to validate the role of EGFR mutation subtypes in treatment outcomes. © 2025 The Authors
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Syiah Kuala, Aceh, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia; Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia; Division of Pulmonology, Department of Internal Medicine Universitas Sriwijaya, Palembang, Indonesia; Department of Pulmonology, Dharmais National Cancer Center Hospital, Jakarta, Indonesia; Division of Medical Oncology, National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
