The inclusion of Dacotinisininin in the first-line status has benefited patients in Asia and 21 L858R.

Recently, the Chinese Society of Clinical Oncology (CSCO) non-small cell lung cancer diagnosis and treatment guide 2020 published online, based on the past year in the field of lung cancer treatment has made significant progress, and a number of relevant studies to obtain positive results to promote the 2020 version of the CSCO NSCLC diagnosis and treatment guidelines updated.
based on this, this newspaper invited Professor Lu Uyu of Huaxi Hospital of Sichuan University to interpret the key points of the guidelines on the updateofing first-line treatment of the late-stage EGFR mutation NSCLC.
Recommended by Guideline I: The new guidelines for the first-line treatment of EGFR mutations in the ntherele of The Dacotinib recommend the addition of "Dacotinib (1A evidence) " and "Ochtinib (1A evidence)."
2019, china's National Drug Administration (NMPA) approved the adaptation of first-line treatment of Dacotinib based on the results of the ARCHER 1050 study, and FLAURA Research NMPA approved the adaptation of ochitini first-line treatment. Note
: Dakhtini is the correct name, and Dakhtini refers to Dacotini in the guide.
CSCO guidelines Grade I recommendations have the following characteristics: accessible universal diagnosis and treatment measures (including clear indicationofie evidence), the relatively stable value of tumor treatment, basically included in the National Health Insurance;
1050 study: Asian patients benefit from survival from Dakotinib, Dakotinib is used for the 19th exnoon deficiency (Del19) and 21 exon L858R gene replacement mutation (L8 58R) local late or metastatic NSCLC patients are a pan HER (EGFR/HER1, HER2 and HER4) inhibitor that can selectively and irreversibly bind to its HER family receptor targets to provide long-acting inhibitors.
, 2-4, binds to the first generation of EGFR TKI and prevents EGFR isopolymerization, which inhibits herfamily receptor homologous dipolymerization and heterogeneous dipolymerization, and inhibits the HER signal transduction pathway more completely.
phase ARCHER 1050 study in Phase III confirmed that the median PFS assessed by the two independent panels was 14.7 months and 9.2 months ( HR - 0.59, bilateral P 0.0001) compared to gifitinib as a first-line treatment.
also accounted for 76.5 percent of asians and 51.1 percent of Chinese patients in the ARCHER 1050 study.
in the Chinese sub-group, the median PFS scored 18.4 months and 11.1 months respectively (HR-0.539, P-0.001).
(Figure 1) 1 ARCHER 1050 study China subgroup data, PFS benefits can be translated into OS benefits (OS extended by 7.1 months, P-0.0155), and as the follow-up time is extended, the OS benefits become more pronounced, and the two survival curves are completely separated.
Dacotini is the only TKI that has OS in the Asian sub-group that has benefited from OS (OS extension of 8.6 months, P - 0.0457).
(Figure 2) 2 Dakotini can convert PFS benefits into OS benefits Covering more effective mutation sites, Dakotini showed good efficacy of 21 exon L858R is Del 19 and 21 exon L858R, and from previous RCT data, EGG FR-TKI's treatment of Del19 is better than 21 exon L858R, which may result in more "co-existing mutations" or "co-mutations" in 21 exon L858R, resulting in a generation and second generation EGFR-TKI to 21 exon L858R PFS and OS data shortened.
therefore, finding drugs that are effective at both mutation sites will give the majority of patients hope for survival.
in the ARCHER 1050 study, OS was 9.3 months longer than the first generation of drugs in patients with positive L858R mutations.
, therefore, the inhibitory effect of dacostini on "mainstream mutations" compared to a generation of gifitinib is also one of the reasons why it has become a first-line drug for the treatment of EGFR lung cancer patients.
the controlled and easy management of dacotinib adverse reactions, the reduction of the effect of EGFR TKIs drugs have similar adverse reactions, but each EGFR-TKI adverse reaction symptoms are different.
the main adverse effects of dacotinib are side effects present in the skin mucosa, such as rash, metagroitis, oral mucositis, and diarrhea, but these are common adverse reactions in EGFR TKI and are manageable and easy to manage.
in addition, clinicians should learn the relevant knowledge of the application of Dacotini, do a good job in the management of adverse reactions, and do a good job of patient education, guide patients to recognize and deal with adverse reactions.
more importantly, the dose adjustment of dacotinib does not affect the efficacy, from 45 mg to 30 mg, or from 45 mg to 30 mg, to 15 mg, the dose adjustment space of dacotinib is large.
(Figure 3) Figure 3 Follows the National Health Network (NCCN) guidelines and the European Society of Oncology (ESMO) guidelines, the CSCO guidelines are based on strong clinical evidence that dacotinib is a first-line recommendation for patients with advanced NSCLC patients with EGFR sensitive mutations.
believe that under the guidance of science, NSCLC patients with EGFR mutations in China will also lead to their own spring, with tumor survival longer and longer.
of course, with the widespread use of new drugs in clinical practice, many questions will need to be explored and answered in the future, such as for patients in Asia and patients with 21 exon L858R mutations, and it is necessary to explore further optimized treatment in order to maximize the benefits of the precise population.
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