Efikasi Afatinib dan Gefitinib pada Pasien Non-small Cell Lung Cancer EGFR Mutasi Positif: Tinjauan Sistematis
Abstract
Tyrosine kinase inhibitors (TKIs) telah direkomendasikan oleh National Comprehensive Cancer Network (NCCN) sebagai terapi lini pertama pada pasien non-small cell lung cancer (NSCLC) dengan mutasi EGFR, yaitu gefitinib (generasi pertama) dan afatinib (generasi kedua). Beberapa penelitian telah dilakukan terkait efikasi golongan TKIs ini, namun masih sedikit yang melakukan tinjauan sistematis (systematic review) secara khusus pada afatinib dan gefitinib. Systematic review ini bertujuan untuk memberikan gambaran secara komprehensif terkait efikasi afatinib dan gefitinib sebagai terapi lini pertama. Database yang digunakan untuk mengidentifikasi studi yang relevan yaitu Science Direct, PubMed dan Google Scholar. Penelitian ini terbatas pada penelitian randomized control trial, penggunaan afatinib dan gefitinib sebagai terapi lini pertama, penggunaan afatinib dan gefitinib secara monoterapi serta artikel yang menggunakan bahasa Inggris. Penelusuran berbasis data elektronik menghasilkan 2089 artikel; 48 artikel yang sudah sesuai dengan judul dan abstrak, namun hanya 8 artikel yang sesuai dengan inklusi yang ingin ditinjau. Secara umum efikasi afatinib dan gefitinib lebih unggul dibandingkan kemoterapi berbasis platinum, dapat dilihat dari progression free survival dari kedua obat ini yang lebih lama dibandingkan kemoterapi berbasis platinum. Walaupun nilai overall survival-nya tidak begitu lebih baik, afatinib dapat memperlambat perkembangan tumor lebih baik dibandingkan gefitinib. Efek samping yang sering terjadi pada afatinib dan gefitinib yaitu ruam dan diare, sedangkan neutropenia, mual, anemia sering terjadi pada penggunaan kemoterapi berbasis platinum. Afatinib dan gefitinib memberikan efikasi yang lebih baik dibandingkan kemoterapi berbasis platinum, namun afatinib memiliki efikasi yang lebih unggul dibandingkan gefitinib dalam pengobatan lini pertama pada pasien NSCLC dengan mutasi EGFR.
Kata kunci: Afatinib, efikasi, gefitinib, non-small cell lung cancer
Afatinib and Gefitinib Efficacy on Non-small Cell Lung Cancer EGFR Mutation Patients: A Systematic Review
Abstract
Tyrosine kinase inhibitors (TKIs) have been recommended by the National Comprehensive Cancer Networks (NCCN) as first-line therapy in non-small cell lung cancer (NSCLC) with EGFR mutation, namely gefitinib (first generation) and afatinib (second generation). Several studies have been conducted related to the efficacy of these TKIs, but few have conducted systematic reviews specifically afatinib and gefitinib. This systematic review aimed to provide a comprehensive overview of the efficacy of gefitinib and afatinib as first-line therapy. To identify the relevant studies, it used several databases such as Science Direct, PubMed, and Google Scholar. The review was limited to the randomized control trial study, the use of afatinib and gefitinib as first-line therapy, the use of afatinib and gefitinib as monotherapy, and articles written in the English language. An electronic data-based search identified 2089 articles; 48 articles matched the title and abstract, yet only 8 articles met the inclusion to be reviewed. In general, the efficacy of afatinib and gefitinib is more effective than platinum-based chemotherapy as showed that the progression-free survival of these medications is longer than platinum-based chemotherapy. Although the overall survival value is not better than platinum-based chemotherapy, afatinib inhibits the tumor growth better compared to gefitinib. Common side-effects in afatinib and gefitinib include rashes and diarrhea, while neutropenia, nausea, and anemia commonly occur in platinum-based chemotherapy. Afatinib and gefitinib offer better efficacy compared to platinum-based chemotherapy. Specifically, the afatinib has greater efficacy compared to gefitinib in first-line therapy for patient with NSCLC EGFR mutation.
Keyword: Afatinib, efficacy, gefitinib, non-small cell lung cancer
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DOI: https://doi.org/10.15416/ijcp.2019.8.4.289
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