The Impact Of Comorbidities And Adverse Events On Quality Of Life In Patients With Egfr-Mutated Non-Small-Cell Lung Cancer (Nsclc) Receiving Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Therapy: A Multicenter Prospective Study.

e21708 Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the standard first-line treatment for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, the impact of comorbidities and treatment-related adverse events (AE) on quality of life (QOL) in patients receiving EGFR-TKI therapy was seldom investigated in a prospective setting. Methods: We conducted a prospective observational study to evaluate the association of comorbidity, AEs, and QOL in patients with EGFR-mutated advanced NSCLC receiving EGFR-TKI as first-line therapy among four hospitals in Taiwan. The questionnaires for QOL and AEs were obtained at baseline, the 2nd, 4th, 12th, and 24th week. Comorbidities were evaluated at baseline by using Simplified Comorbidity Score (SCS). The QOL was assessed by using EORTC QLQ-C30, QLQ-LC-13, and dermatology life quality index (DLQI). Paronychia related to oncologic treatments (SPOT) scale was used for paronychia severity evaluation. Visual analogue score (VAS) was applied for pain and itching evaluation. AE was recorded by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The correlations between QOL and comorbidities as well as AEs were analyzed by generalized estimating equation. Results: A total of 110 patients were included. Comorbidities were not associated with QOL deterioration (p= 0.209). While assessed by QLQ-LC13, mucositis (p= 0.001), elevated aminotransferase levels (p= 0.046), and use of oral antibiotic for dermatitis (p= 0.009) were associated with QOL deterioration. There was no significant difference in QOL among patients receiving afatinib, erlotinib, or gefitinib therapy. Gefitinib and afatinib showed a trend of improved QOL assessed by QLQ-C30 and LC13, whereas erlotinib with a trend of deteriorated QOL by LC13 (effect size = 0.07). For dermatological toxicities, a trend of deterioration in QOL was observed by DLQI assessment in patients received erlotinib (effect size = 7.44) or afatinib (effect size = 0.71). SPOT scale was higher in patients taking afatinib (p= 0.002). VAS pain score was higher in those taking afatinib (p= 0.005) or erlotinib (p= 0.049). Conclusions: Comorbidities and the choice of EGFR-TKI have no impact on overall QOL in advanced NSCLC patients receiving EGFR-TKI therapy. Mucositis, impaired liver function, and dermatitis needed oral antibiotics use may lead to a QOL deterioration.