Real-world analysis of afatinib as a first-line treatment for patients with advanced stage non-small-cell lung cancer with uncommon EGFR mutations: a multicenter study in Vietnam.

Background: Afatinib is indicated for advanced-stage non-small-cell lung cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) and uncommon mutations. However, real-world studies on this topic are limited. This study aimed to evaluate afatinib as first-line therapy for locally advanced and metastatic NSCLC with uncommon EGFR mutations. Patients and methods: A retrospective study included 92 patients with advanced NSCLC with uncommon and compound EGFR mutations, treated with afatinib as first-line therapy. Patients were followed up and evaluated every 3 months or when symptoms of progressive disease arose. The endpoints were objective response rate (ORR), time-to-treatment failure (TTF), and adverse events. Results: The G719X EGFR mutation had the highest occurrence rate (53.3% for both monotherapy and the compound). By contrast, the compound mutation G719X-S768I was observed at a rate of 22.8%. The ORR was 75%, with 15.2% of patients achieving complete response. The overall median TTF was 13.8 months. Patients with the G719X EGFR mutation (single and compound) had a median TTF of 19.3 months, longer than that of patients with other mutations, who had a median TTF of 11.2 months. Patients with compound EGFR mutations (G719X and S768I) demonstrated a median TTF of 23.2 months compared to that of 12.3 months for other mutations. Tolerated doses of 20 or 30 mg achieved a longer median TTF of 17.1 months compared to 11.2 months with 40 mg. Median TTF differed between patients with and without brain metastasis, at 11.2 and 16.9 months, respectively. Rash (55.4%) and diarrhea (53.3%) were the most common adverse events, primarily grades 1 and 2. Other side effects occurred at a low rate. Conclusion: Afatinib is effective for locally advanced metastatic NSCLC with uncommon EGFR mutations. Patients with G719X, compound G719X-S768I mutations, and tolerated doses of 20 or 30 mg had a longer median TTF than those with other mutations.

A real-world cohort study of first-line afatinib in patients with EGFR-mutant advanced non-small cell lung cancer in Vietnam.

BACKGROUND: This study aimed to evaluate the efficacy and side effects of first-line afatinib treatment in a real-world setting in Vietnam. METHODS: This retrospective study was conducted across nine hospitals in Vietnam. Advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients who received afatinib as first-line therapy between April 2018 and June 2022 were included, and patient medical records were reviewed. Key outcomes were overall response rate (ORR), time-to-treatment failure (TTF), and tolerability. RESULTS: A total of 343 patients on first-line afatinib were eligible for the study. EGFR exon 19 deletion (Del19) alone was detected in 46.9% of patients, L858R mutation alone in 26.3%, and other uncommon EGFR mutations, including compound mutations, in 26.8%. Patients with brain metastases at baseline were 25.4%. Patients who received 40 mg, 30 mg, and 20 mg as starting doses of afatinib were 58.6%, 39.9%, and 1.5%, respectively. The ORR was 78.1% in the overall population, 82.6% in the Del19 mutation subgroup, 73.3% in the L858R mutation subgroup, and 75.0% in the uncommon mutation subgroup (p > 0.05). The univariate and multivariate analyses indicate that the ORR increased when the starting dose was 40 mg compared to starting doses below 40 mg (83.9% vs. 74.3%, p = 0.034). The median TTF (mTTF) was 16.7 months (CI 95%: 14.8-18.5) in all patients, with a median follow-up time of 26.2 months. The mTTF was longer in patients in the common EGFR mutation subgroup (Del19/L858R) than in those in the uncommon mutation subgroup (17.5 vs. 13.8 months, p = 0.045) and in those without versus with brain metastases at baseline (17.5 vs. 15.1 months, p = 0.049). There were no significant differences in the mTTF between subgroups based on the starting dose of 40 mg and < 40 mg (16.7 vs. 16.9 months, p > 0.05). The most common treatment-related adverse events (any grade/grade ≥ 3) were diarrhea (55.4%/3.5%), rash (51.9%/3.2%), paronychia (35.3%/5.0%), and stomatitis (22.2%/1.2%). CONCLUSIONS: Afatinib demonstrated clinical effectiveness and good tolerability in Vietnamese EGFR-mutant NSCLC patients. In our real-world setting, administering a starting dose below 40 mg might result in a reduction in ORR; however, it might not have a significant impact on TTF.

Cognitive Radio-Assisted NOMA Broadcasting for 5G Cellular V2X Communications: Model of Roadside Unit Selection and SWIPT.

The outage performance is a significant problem to implement the Cognitive Radio (CR) paradigm in the Vehicle to Everything (V2X) networks. Recently, more interest has focused on Non-Orthogonal Multiple Access (NOMA) in wireless-powered communication. In the conventional CR-enabled V2X-NOMA network, spectrum sensing and limited battery capacity at the Roadside Unit (RSU) may cause serious outage performance. In this study, RSU selection scheme is adopted. This paper presents an interesting model of a system with Simultaneous Wireless Information and Power Transfer (SWIPT) and a CR-enabled V2X-NOMA network. In the downlink, the RSU harvests wireless energy from Radio Frequency (RF) signals and senses the spectrum state at the same time. A CR-enabled V2X-NOMA system performance is presented by deriving exact expressions of outage probability of distant vehicles. In the overlay CR-enabled V2X-NOMA network, the constraints are transmit power and the number of designed RSU that make significant impacts on system performance. Simulation results show that the CR-enabled V2X-NOMA get benefits from energy harvesting and RSU selection scheme.

Exploiting Joint Base Station Equipped Multiple Antenna and Full-Duplex D2D Users in Power Domain Division Based Multiple Access Networks.

In this paper, we investigate power domain division-based multiple access (PDMA) to support the base stations (BS) equipped with multiple antennas to serve mobile users. Such a system deploys multiple input single output (MISO)-based wireless transmission and a full-duplex (FD) scheme. Furthermore, such MISO PDMA system consists of BS employing transmit antenna selection to reduce complexity in signal processing at the receivers. We distinguish two kinds of mobile users, device-to-device (D2D) users and traditional users. In such MISO PDMA, there exists a trade-off between outage performance of each PDMA user and power allocation factors. Since the implementation of the FD scheme at PDMA users, bandwidth efficiency will be enhanced despite the existence of self-interference related to such FD. In particular, exact expressions of outage probability are derived to exhibit system performance with respect to D2D users. Finally, valuable results from the simulated parameters together with the analytical results show that MISO PDMA can improve its performance by increasing the number of transmit antennas at the BS.

NOMA-Assisted Multiple Access Scheme for IoT Deployment: Relay Selection Model and Secrecy Performance Improvement.

In this paper, an Internet-of-Things (IoT) system containing a relay selection is studied as employing an emerging multiple access scheme, namely non-orthogonal multiple access (NOMA). This paper proposes a new scheme to consider secure performance, to be called relay selection NOMA (RS-NOMA). In particular, we consider metrics to evaluate secure performance in such an RS-NOMA system where a base station (master node in IoT) sends confidential messages to two main sensors (so-called NOMA users) under the influence of an external eavesdropper. In the proposed IoT scheme, both two NOMA sensors and an illegal sensor are served with different levels of allocated power at the base station. It is noticed that such RS-NOMA operates in two hop transmission of the relaying system. We formulate the closed-form expressions of secure outage probability (SOP) and the strictly positive secure capacity (SPSC) to examine the secrecy performance under controlling setting parameters such as transmit signal-to-noise ratio (SNR), the number of selected relays, channel gains, and threshold rates. The different performance is illustrated as performing comparisons between NOMA and orthogonal multiple access (OMA). Finally, the advantage of NOMA in secure performance over orthogonal multiple access (OMA) is confirmed both analytically and numerically.