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Osimertinib beyond disease progression in T790M EGFR-positive NSCLC patients: a multicenter study of clinicians'

A Cortellini1,2, A Leonetti3, A Catino4

  • 1Medical Oncology Unit, St. Salvatore Hospital, Via Vetoio, 67100, L'Aquila, Italy. alessiocortellini@gmail.com.

Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
|August 9, 2019
PubMed
Abstract

Insights

Continuing osimertinib beyond progression, with or without local ablative treatments (LATs), significantly improves progression-free survival and overall survival for patients with T790M EGFR-positive non-small cell lung cancer.

Area of Science:

  • Oncology
  • Medical Science
  • Clinical Research

Background:

  • Non-small cell lung cancer (NSCLC) patients with T790M EGFR mutations often experience "non-druggable" progression after osimertinib treatment.
  • Chemotherapy is standard for NSCLC, but local ablative treatments (LATs) may help in cases of limited or "oligo-progression."

Purpose of the Study:

  • To evaluate post-progression outcomes in T790M EGFR-positive NSCLC patients treated with osimertinib.
  • To compare different therapeutic strategies after disease progression: osimertinib beyond progression (with or without LATs), switched therapies, or best supportive care (BSC).

Main Methods:

  • A study was conducted on 144 consecutive patients with T790M EGFR-positive NSCLC who received osimertinib.
  • Patients were categorized based on post-progression treatment: BSC, osimertinib beyond progression (with or without LATs), or switched therapies.

Main Results:

  • Patients receiving osimertinib beyond progression showed significantly longer median progression-free survival (6.4 months) and overall survival (11.3 months) compared to those on switched therapies (4.7 and 7.8 months, respectively).
  • Among patients on osimertinib beyond progression, those who also received LATs had a longer median overall survival (20.2 months) compared to those without LATs (9.9 months).
  • Therapeutic strategy favoring osimertinib beyond progression (± LATs) was the only significant factor related to progression-free survival and overall survival.

Conclusions:

  • Continuing osimertinib beyond progression, particularly with adjunctive LATs, is a viable and effective strategy for managing "non-druggable" disease progression in T790M EGFR-positive NSCLC.
  • This approach offers improved survival outcomes compared to switching therapies or best supportive care alone.
Keywords:
Beyond progressionEGFRNSCLCOsimertinibProgression of diseaseT790M

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