Real-World Treatment Patterns of Metastatic Epidermal Growth Factor Receptor (EGFR)-Mutated Non-small Cell Lung...

Introduction Targeted therapies have transformed the treatment landscape of metastatic non-small cell lung cancer (mNSCLC) and are the preferred first-line (1L) treatment option for patients with mNSCLC harboring epidermal growth factor receptor (EGFR) exon 19 deletion (Ex19del) and exon 21 L858R substitution (L858R). However, recent real-world data on patient characteristics and treatment patterns in this population remain limited. This study aimed to describe treatment patterns, including immunotherapy use, in patients with EGFR-mutated (Ex19del/L858R) mNSCLC. Methods This retrospective study descriptively analyzed deidentified Integra Connect data for patients with documented EGFR-mutated (Ex19del/L858R) mNSCLC before initiating 1L treatment on or after January 1, 2018, with 1L initiation as the index date. Results Among 561 patients, the median age was 71 years; 369 (66.1% of 558 patients with known gender information) were female, 375 (66.8%) were White, and 290 (51.9% of 559 patients with known smoking status) never smoked. Ex19del was reported in 286 patients (51.0%) and L858R in 276 (49.2%). Most patients (n = 408, 72.7%) had documented next-generation sequencing testing. The mean (median) time from first recorded metastasis date to 1L initiation was 3.5 (1.1) months. The mean (median) time from first recorded EGFR-positive (Ex19del/L858R) test or test result and 1L initiation was 2.7 (0.5) months. The most common 1L treatments included osimertinib monotherapy (n = 419, 74.7%) and osimertinib combination therapies (n = 61, 10.9%). By data cutoff (June 30, 2024), 245 patients (43.7%) had received a second-line (2L) therapy. Common 2L treatments included chemotherapy-immunotherapy combinations (n = 48, 19.6%), osimertinib monotherapy (n = 42, 17.1%), and immunotherapy monotherapy (n = 25, 10.2%). Overall, 53 patients (9.4%) received immunotherapy as 1L treatment, while nearly one-third (n = 77, 31.4%) of those initiating 2L therapy received immunotherapy. Conclusions Despite guidelines recommending targeted therapy over immunotherapy in patients with EGFR-mutated (Ex19del/L858R) mNSCLC, immunotherapy use in 1L and 2L continues to be observed in the real world, highlighting substantial unmet needs and the need for more effective targeted treatments for these patients.