There was a significant difference in median progression-free survival (mPFS) by therapeutic strategy (P = 0.017). The mPFS of 1G TKI, 2G TKI afatinib, chemotherapy, and 1G TKI in combination with chemotherapy were 7.7 (95% CI, 4.2-11.2), 11.3 (95% CI, 5.6-17.0), 5.0 (95% CI, 2.3-17.7), and 11.1 (95% CI, 5.9-16.4) months, respectively....Like afatinib, 1G TKI in combination with chemotherapy might be an effective treatment option for patients harboring EGFR exon 18 mutations.