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Patterns of progression on osimertinib in EGFR T790M positive NSCLC: A Swiss cohort study

S Schmid1, D Klingbiel2, S Aeppli1

  • 1Department of Oncology/Haematology, Cantonal Hospital St. Gallen, University of Bern Switzerland, Switzerland.

Lung Cancer (Amsterdam, Netherlands)
|March 20, 2019
PubMed
Abstract

Insights

Osimertinib resistance in EGFR T790M-positive non-small cell lung cancer often presents as limited progression (oligo-progression). Treating oligo-progression with local ablative therapy (LAT) alongside osimertinib shows favorable outcomes, supporting treatment beyond progression.

Area of Science:

  • Oncology
  • Pharmacology
  • Genetics

Background:

  • Osimertinib is an EGFR tyrosine kinase inhibitor (TKI) effective for non-small cell lung cancer (NSCLC) with EGFR T790M mutations.
  • The pattern and incidence of disease progression on osimertinib, specifically oligo-progression (PD), are not well-defined.

Purpose of the Study:

  • To investigate the incidence of oligo-progression in patients with EGFR T790M-positive NSCLC treated with osimertinib.
  • To evaluate the outcomes of patients with oligo-progression and the role of local ablative treatment (LAT).

Main Methods:

  • Retrospective analysis of 50 pre-treated EGFR T790M-positive NSCLC patients receiving osimertinib.
  • Oligo-progression defined as progression in ≤ 5 lesions.
  • Mutational profiling of tumor samples before and after osimertinib treatment.

Main Results:

  • Oligo-progression (PD) occurred in 73% of patients who progressed on osimertinib.
  • Median treatment duration was significantly longer for oligo-PD (19.6 months) compared to systemic PD (7 months).
  • Patients receiving LAT for oligo-PD had favorable outcomes, with 16 patients continuing osimertinib beyond progression.

Conclusions:

  • Acquired resistance to osimertinib in EGFR T790M-positive NSCLC frequently manifests as oligo-progression.
  • Local ablative treatment (LAT) for progressing lesions in oligo-PD patients is associated with favorable outcomes.
  • Osimertinib treatment can be continued beyond progression in select cases, particularly when combined with LAT for emergent lesions.
Keywords:
Local ablative therapyNSCLC advancedOligoprogressionOsimertinib

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