Efficacy and safety of afatinib in Chinese patients with EGFR-mutated metastatic non-small-cell lung cancer (NSCLC) previously responsive to first-generation tyrosine-kinase inhibitors (TKI) and chemotherapy: comparison with historical cohort using erlotinib.

BACKGROUND: Afaitnib has shown anti-tumor activity against metastatic EGFR-mutated NSCLC after prior failure to first generation EGFR-TKI and chemotherapy. We prospectively evaluated the efficacy and safety of afatinib in Chinese patients who previously failed first-generation TKI and chemotherapy under a compassionate use program (CUP) and compared to the erlotinib cohort. METHODS: Patients who suffered from metastatic EGFR-mutated NSCLC previously responsive to first-generation TKI and chemotherapy received afatinib until progression, loss of clinical benefits or intolerable toxicity. Treatment response, survival and safety were evaluated and compared to the erlotinib cohort. RESULTS: Twenty-five and 28 patients received afatinib and erlotinib respectively. More patients in the afatinib group had worse performance status (ECOG 2) than the erlotinib group (p = 0.008). After a median follow-up of 12.1 months, afatinib demonstrated comparable objective response rate (ORR) (20.0% vs. 7.1%, p = 0.17) but significantly higher disease control rate (DCR) (68.0% vs. 39.3%, p = 0.04) compared to erlotinib. Median progression-free survival (PFS) (4.1 months [95% CI, 2.7-5.5 months] vs. 3.3 months [95% CI, 2.2-4.3 months], p = 0.97) and overall survival (OS) were not different between the two groups (10.3 months [95% CI, 7.5-13.0 months] vs. 10.8 months [95% CI, 7.4-14.2 months], p = 0.51). Multivariate analyses revealed that age ≤ 70 years and time to progression (TTP) ≥ 18 months for the 1st TKI therapy were prognostic of PFS (p = 0.006 and p = 0.008 respectively). Afatinib caused less rash (60.0% vs. 67.9%, p = 0.04) but more diarrhea (60.0% vs. 10.7%, p = 0.002) compared to erlotinib. CONCLUSION: Afatinib produced encouraging clinical efficacy as 2nd TKI therapy with manageable safety profiles in our Chinese patients after failure to another TKI and systemic chemotherapy. This study was registered at ClinicalTrials.gov (NCT02625168) on 3rd December 2015.

Comparing the effects of rehabilitation swallowing therapy vs. functional neuromuscular electrical stimulation therapy in an encephalitis patient: a case study.

A 49-year-old man with pharyngeal dysphagia after encephalitis is presented in this case study. Sixteen months earlier the patient experienced a sudden severe fever which resulted in encephalitis, leading to liquid dysphagia. Despite receiving an initial treatment of swallowing therapy, the patient's liquid dysphagia did not improve. Functional neuromuscular electrical stimulation, which is a new treatment method, was then applied to the patient. The patient showed improvement in the pharyngeal phase of swallowing. Clinical and treatment observations are reported.

The validation of the Chinese version of the Swallow Quality-of-Life Questionnaire (SWAL-QOL) using exploratory and confirmatory factor analysis.

The aim of this work was to study the psychometric properties of the Chinese version of the Swallow Quality-of-Life Questionnaire (CSWAL-QOL) validated in the Hong Kong Chinese-speaking population. With convenience sampling, a cross-sectional survey was launched to evaluate the validity and reliability of the CSWAL-QOL. One hundred subjects with swallowing problems were recruited to evaluate the construct validity and internal consistency, and 20 subjects were recruited for the test-retest reliability. Construct validity was validated through factor analysis (both exploratory and confirmatory) and a correlation study between the CSWAL-QOL and the World Health Organization Quality-of-Life Questionnaire-abbreviated version [WHOQOL-BREF (HK)]. Reliability was estimated using tests of internal consistency and test-retest reliability. The psychometric properties of the CSWAL-QOL were found to be largely similar to those of the SWAL-QOL, except the three-item eating desire scale of the CSWAL-QOL, which showed insignificant results in the validity and reliability tests. The CSWAL-QOL is the first validated Chinese version of the SWAL-QOL in Hong Kong. It is a clinically valid and reliable tool for assessing the quality of life in dysphagic Chinese patients in Hong Kong, regardless of the causes of dysphagia.