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Real-World Outcomes and Subsequent Treatment Patterns in Patients with Advanced Non-Small Cell Lung Cancer and
Jorge J Nieva1, Xuejun Wang2, Deborah Doroshow2
1Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue NOR 3440, Los Angeles, CA, 91103, USA. jorge.nieva@med.usc.edu.
Introduction:
Osimertinib is recommended, alongside afatinib, as first-line treatment for patients with advanced non-small cell lung cancer (NSCLC) with atypical mutations in the epidermal growth factor receptor gene (EGFR), a population for whom real-world data are limited. We present outcomes and subsequent treatment patterns for this population in routine US practice.
Methods:
Medical records from a manually curated oncology database were analyzed for adults with stage IIIB-IV NSCLC harboring atypical EGFR mutations, treated with first-line osimertinib (April 2018-March 2020). Data were analyzed overall and by EGFR mutation subgroups: compound EGFR mutations, comprising classical (exon [Ex] 19 deletion or L858R) and atypical (G719X, L861Q, S768I, E709X, Ex19 insertions, or Ex18-25 duplications) mutations or de novo T790M only (group A), and atypical EGFR mutations only (group B). Outcomes included real-world progression-free survival (rwPFS) and overall survival (OS).
Results:
A total of 55 patients were included in the study (female 76%/male 24%; group A, n = 20; group B, n = 35). After a median follow-up of 11 months, median (95% confidence interval) rwPFS and OS, respectively, were 8.8 (5.5-17.2) and 28.5 months (11.4-41.8) overall, 20.3 (10.0-44.5) and 42.5 months (27.0-not estimable) in group A, and 6.6 (4.9-24.8) and 20.0 months (9.2-32.9) in group B. At follow-up, 13% of patients (n = 7) remained on first-line osimertinib (group A, 30%; group B, 3%), 54% (n = 30) had discontinued due to death (group A, 40%; group B, 63%), and 33% (n = 18) had received subsequent treatment (group A, 30%; group B, 34%), most commonly osimertinib combinations (28%; n = 5).
Conclusions:
First-line osimertinib may provide real-world clinical benefits for patients with advanced NSCLC with atypical EGFR mutations, with results suggesting greater benefit in those harboring compound EGFR mutations.
Insights
First-line osimertinib shows real-world clinical benefits for advanced non-small cell lung cancer (NSCLC) patients with atypical EGFR mutations. Compound EGFR mutations may indicate a greater benefit in this patient population.
Area of Science:
- Oncology
- Medical Genetics
- Pharmacology
Background:
- Osimertinib is a recommended first-line treatment for advanced non-small cell lung cancer (NSCLC) with atypical EGFR mutations.
- Real-world data for this specific patient population are limited.
- This study addresses the need for real-world evidence in routine US practice.
Purpose of the Study:
- To evaluate the real-world outcomes of first-line osimertinib treatment in advanced NSCLC patients with atypical EGFR mutations.
- To analyze subsequent treatment patterns in this patient group.
- To compare outcomes between different subgroups of atypical EGFR mutations.
Main Methods:
- Retrospective analysis of medical records from an oncology database.
- Inclusion criteria: adults with stage IIIB-IV NSCLC, atypical EGFR mutations, treated with first-line osimertinib (April 2018-March 2020).
- Patients were categorized into two groups: compound EGFR mutations (including classical and atypical) or de novo T790M only (Group A), and atypical EGFR mutations only (Group B).
Main Results:
- 55 patients were analyzed; median follow-up was 11 months.
- Median real-world progression-free survival (rwPFS) was 8.8 months and median overall survival (OS) was 28.5 months.
- Patients with compound EGFR mutations (Group A) showed longer median rwPFS (20.3 months) and OS (42.5 months) compared to those with atypical mutations only (Group B).
Conclusions:
- First-line osimertinib demonstrates real-world clinical benefits for advanced NSCLC patients with atypical EGFR mutations.
- The study suggests a potentially greater benefit for patients with compound EGFR mutations.
- Real-world data support the use of osimertinib in this challenging patient subgroup.
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