BackgroundAfatinib is a second generation irreversible EGFR tyrosine kinase inhibitor (TKI), indicated as firstline therapy in non-small cell lung cancer (NSCLC). There are two other first generation EGFR TKIs indicated in NSCLC treatment, and no direct comparison of them.PurposeTo compare the efficacy of afatinib versus erlotinib or gefitinib in EGFR TKIs naïve patients with NSCLC.Material and methodsThis was an observational retrospective study carried out between January 2015 and April 2016. All patients with NSCLC undergoing firstline treatment with an EGFR TKI were included. Patient data were taken from clinical records. Efficacy endpoints were overall survival (OS), progression free survival (PFS) and response rate, assessed by RECIST criteria.Results46 patients were included. 76% were men, average age was 71 years. 71.8% had an ECOG performance status of 0–1 and 76% were current or past smokers. NSCLC stage was III/IV in 84.4% of patients and histologic type was adenocarcinoma in 37% of patients. 43.5% were treated with erlotinib, 39.9% with gefitinib and 17.4% with afatinib. EGFR status was determined in only 16 patients, being mutated in 7 (4 treated with erlotinib and the other 3 with afatinib). Median OS for afatinib, gefitinib and erlotinib was 5, 14 and 43 months, respectively (HR (95% CI) gefitinib vs afatinib: 0.25 (0.07–0.81); erlotinib vs afatinib: 0.16 (0.05–0.55)). Median PFS was 2 months for afatinib, 8 months for gefitinib and 16 months for erlotinib (HR (95% CI) gefitinib vs afatinib: 0.18 (0.06–0.59); erlotinib vs afatinib: 0.08 (0.02–0.29)). Response rate by group was 37.5%, 61.1% and 80% for afatinib, gefitinib and erlotinib, respectively.ConclusionAccording to the main clinical guidelines, EGFR mutation status should be known before the start of treatment, and EGFR TKIs should only be used in patients with a positive EGFR mutation test. Our study suggests that afatinib is less effective than erlotinib or gefitinib, but our population was small. Further studies with more patients are needed to compare afatinib with the other EGFR TKIs.References and/or acknowledgementsSequist LV, Yang JC-HC-H, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol2013;31:1–11.No conflict of interest
Background
Axillary hyperhidrosis is based on a continuous, symmetric sweating of axillae that often leads to emotional distress and occupational disability. It affects 0.6–1% of younger people in the western world. When topical treatment doesn’t relieve the sweating, surgical botulinum toxin treatment, which prevents calcium-dependent acetylcholine release from the sympathetic sweat glands, is an attractive alternative to ganglion sympathectomy. Last year, fifteen patients took this treatment in the Thoracic Surgery service of our hospital.
Purpose
To investigate how the quality of life changes after botulinum toxin surgery in axillary hyperhidrosis patients, as a way to qualitatively assess its effect.
Materials and methods
Patient information was collected from our hospital databases. In October 2013, using a standardised dermatological life-quality questionnaire (DLQI, Finlay & Khan), we asked patients ten questions by phone covering their emotional, clinical, interpersonal and work issues before and after surgery. Finally, we performed a Shapiro-Wilk test (normality) on SPSS and a paired Student’s t-test (comparing means).
Results
Data were gathered from ten patients (seven women, average age of 35.4 ± 6.69). For six of them, the disease started in childhood; and for the remaining four after puberty or in their early twenties. All of them had tried aluminium-based products, with no results. Using a scale of 30 points (the higher the score, the worse the quality of life), the average score decreased by 16 ± 2.82 points (p-value < 0.001, from 19.4 before surgery to 3.4 after). This reduction was marked in all issues considered except for interpersonal relationships (positive opinion before and after). All but one mentioned a significant decrease in sweating, which now only happens when practicing sports.
Conclusions
Despite the effect only lasting for about six months, botulinum toxin surgery clearly improves quality of life in axillary hyperhidrosis patients, who are satisfied with the intervention and were keen to repeat it when the effect disappears.
No conflict of interest.
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