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Updated: Feb 15, 2026
Profiling Sensitivity to Targeted Therapies in EGFR-Mutant NSCLC Patient-Derived Organoids
Published on: November 22, 2021
Clinical management and outcome of patients with advanced NSCLC carrying EGFR mutations in Spain
Edurne Arriola1, Ramón García Gómez2, Pilar Diz3
1Medical Oncology Department, Hospital del Mar, Passeig Marítim, 25-29, 08018, Barcelona, Spain. earriola@parcdesalutmar.cat.
Background:
Although the benefit of first-line epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) over chemotherapy has been demonstrated in several clinical trials, data from clinical practice is lacking and the optimal EGFR TKI to be used remains unclear. This study aims to assess the real-life diagnostic and clinical management and outcome of patients with advanced non-small-cell lung cancer (NSCLC) carrying EGFR mutations in Spain.
Methods:
All consecutive patients recently diagnosed with advanced or metastatic NSCLC from April 2010 to December 2011 in 18 Spanish hospitals and carrying EGFR mutations were retrospectively evaluated.
Results:
Between March and November 2013, a total of 187 patients were enrolled (98.3% Caucasian, 61.9% female, 54.9% never-smokers, 89.0% adenocarcinoma). Mutation testing was mainly performed on biopsy tumour tissue specimens (69.0%) using a qPCR-based test (90%) (47.0% Therascreen EGFR PCR Kit). Common sensitising mutations were detected in 79.8% of patients: 57.1% had exon 19 deletions and 22.6% exon 21 L858R point mutations. The vast majority of patients received first-line therapy (n = 168; 92.8%). EGFR TKIs were the most commonly used first-line treatment (81.5%), while chemotherapy was more frequently administered as a second- and third-line option (51.9% and 56.0%, respectively). Of 141 patients who experienced disease progression, 79 (56.0%) received second-line treatment. After disease progression on first-line TKIs (n = 112), 33.9% received chemotherapy, 8.9% chemotherapy and a TKI, and 9.8% continued TKI therapy. Most patients received first-line gefitinib (83.0%), while erlotinib was more frequently used in the second-line setting (83.0%). Progression-free survival (PFS) and overall survival (OS) in patients harbouring common mutations were 11.1 months and 20.1 months respectively (exon 19 deletions: 12.4 and 21.4 months; L858R: 8.3 and 14.5 months), and 3.9 months and 11.1 months respectively for those with rare mutations.
Conclusion:
EGFR TKIs (gefitinib and erlotinib) are used as the preferred first-line treatment while chemotherapy is more frequently administered as a second- and third-line option in routine clinical practice in Spain. In addition, efficacy data obtained in the real-life setting seem to concur with data from EGFR TKI phase III pivotal studies in NSCLC.
Insights
In Spain, epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) are the preferred first-line treatment for advanced non-small-cell lung cancer (NSCLC) with EGFR mutations. Real-world data confirm their efficacy, with chemotherapy used more in later lines.
Area of Science:
- Oncology
- Medical Practice
Background:
- Clinical trials show benefits of first-line EGFR TKIs over chemotherapy for advanced NSCLC.
- Optimal EGFR TKI choice and real-world data are lacking.
- This study assesses real-life management and outcomes in Spanish NSCLC patients with EGFR mutations.
Purpose of the Study:
- To evaluate the real-world diagnostic and clinical management of advanced NSCLC patients with EGFR mutations in Spain.
- To assess the outcomes of these patients under current clinical practice.
- To compare real-world efficacy data with findings from pivotal clinical trials.
Main Methods:
- Retrospective evaluation of consecutive advanced/metastatic NSCLC patients with EGFR mutations diagnosed between April 2010 and December 2011 in 18 Spanish hospitals.
- Data collected on patient demographics, mutation testing, first-line and subsequent treatments, and survival outcomes.
- Analysis of progression-free survival (PFS) and overall survival (OS) based on mutation type and treatment received.
Main Results:
- 187 patients enrolled; 79.8% had common sensitizing mutations (57.1% exon 19 deletions, 22.6% exon 21 L858R).
- EGFR TKIs were the primary first-line treatment (81.5%), while chemotherapy was more common in second/third-line settings (51.9%-56.0%).
- Median PFS and OS for common mutations were 11.1 and 20.1 months, respectively; rare mutations showed shorter survival (3.9 and 11.1 months).
Conclusions:
- EGFR TKIs (gefitinib, erlotinib) are the preferred first-line therapy for advanced NSCLC with EGFR mutations in Spanish clinical practice.
- Chemotherapy is predominantly used as a second- and third-line treatment.
- Real-world efficacy data for EGFR TKIs in NSCLC align with findings from pivotal clinical trials.
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