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Published on: September 8, 2023
Outcomes of Patients with EGFR-Mutant Advanced NSCLC in a Developing Country in Southeast Asia
Soon Hin How1,2, Chong Kin Liam3, Muhammad Adil Zainal Abidin1
1Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Background:
Although first- and second-generation EGFR TKIs are considered first-line treatment in EGFRm+ NSCLC, most patients develop resistance and progress, commonly, EGFR T790M mutation. The third-generation EGFR-TKI has demonstrated efficacy in patients with progressive disease harboring the T790M mutation and in the first-line setting, bypassing this mode of resistance. The primary objectives of this study are to describe the proportion of EGFRm+ NSCLC patients treated with first-, second- and third-generation EGFR TKIs, and cytotoxic chemotherapy in the first-line setting, and the time on treatment for each category. Secondary objectives are to determine the dropout rate, the rates for T790M mutation testing at disease progression and the type of subsequent treatment.
Methods:
This multicenter retrospective study utilized data from the Malaysian Lung Cancer Registry that actively registers all lung cancer patients ≥18 years, with primary lung cancer confirmed histologically or cytologically. All patients diagnosed with advanced stages (ie stages IIIB, IIIC and IV) EGFRm+ NSCLC from 1st of January 2015 to 31st December 2019 were included.
Results:
Of 406 patients with EGFRm+ NCSLC, 351 were treated. Types of first-line treatment were as follows: EGFR-TKIs (first generation - 54.1%, second generation - 25.6% and third-generation - 12.5%) and chemotherapy (7.7%). The median time of treatment for each generation of EGFR-TKI was 12 months, 12 months and 24 months, and 2 months for chemotherapy. The dropout rate was 28.7% (n = 101). Nearly half (49.4%) of patients who were on first- or second-generation EGFR-TKI had further genetic testing via liquid or tissue biopsies upon disease progression. About 24.9% of those who developed disease progression after first- or second-generation EGFR TKI were started on a third-generation EGFR TKI.
Conclusion:
In the real-world, the management of EGFRm+ advanced NSCLC patients in an Asian cost-restrictive setting may adversely affect the choice of first-line therapy, time on each line of treatment and subsequently the overall survival of patients.
Insights
This study examines first-line treatments for EGFR mutation-positive non-small cell lung cancer (NSCLC) in Malaysia. Third-generation EGFR TKIs showed longer treatment times, but cost-restrictive settings may impact patient outcomes.
Area of Science:
- Oncology
- Pharmacology
- Genetics
Background:
- First- and second-generation EGFR TKIs are standard for EGFR mutation-positive NSCLC but often lead to resistance via EGFR T790M mutation.
- Third-generation EGFR TKIs offer efficacy against T790M resistance and can be used in the first-line setting.
- Understanding treatment patterns and outcomes in real-world settings is crucial for optimizing patient care.
Purpose of the Study:
- To determine the proportion of EGFR mutation-positive NSCLC patients receiving first-, second-, and third-generation EGFR TKIs or chemotherapy as first-line treatment.
- To analyze treatment duration for different first-line therapies.
- To assess dropout rates, T790M mutation testing frequency, and subsequent treatment choices.
Main Methods:
- A multicenter retrospective study using data from the Malaysian Lung Cancer Registry (2015-2019).
- Inclusion criteria: Patients aged ≥18 with histologically or cytologically confirmed advanced (Stage IIIB-IV) EGFR mutation-positive NSCLC.
- Data collected on first-line treatment type, duration, dropout rates, T790M testing, and subsequent therapies.
Main Results:
- Of 351 treated patients, first-line treatments included first-generation EGFR-TKIs (54.1%), second-generation (25.6%), third-generation (12.5%), and chemotherapy (7.7%).
- Median treatment times were 12 months for first- and second-generation TKIs, 24 months for third-generation TKIs, and 2 months for chemotherapy.
- Dropout rate was 28.7%. 49.4% of patients on first/second-gen TKIs underwent T790M testing upon progression, with 24.9% subsequently treated with third-gen TKIs.
Conclusions:
- Real-world management of advanced EGFR mutation-positive NSCLC in Asian, cost-restrictive settings may influence first-line therapy selection and treatment duration.
- These factors can potentially impact overall survival.
- Further research is needed to optimize treatment strategies within resource-limited environments.
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