1227P Stereotactic body radiotherapy to the lung primary lesion improves the survival of patients with non-oligometastatic NSCLC harboring EGFR activating mutation with first-line EGFR-TKIs: A real-world study

BackgroundFirst-generation or second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are commonly used in EGFR-mutation-positive advanced non-small-cell lung cancer (NSCLC) with no relevant differences in efficacy in randomised clinical trials (RCTs). Patients enrolled to RCTs may differ from NSCLC population in everyday practice. Limited real-world experience (RWE) exists on efficacy of EGFR TKIs in European patient cohorts.Patients and methodsIn this retrospective study, real-world data of all patients who started first-line EGFR TKIs between 2012 and 2016 in Poland were analysed. The main endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints were an objective response rate and toxicity.ResultsA total of 620 treatment-naive EGFR mutated patients with stage III/IV NSCLC were analysed with follow-up time of 24.5 months. A significantly longer median PFS (p=0.005) and higher 1-year OS rate (p=0.004) for afatinib (16.4 months and 78.2%) vs gefitinib (10.3 months and 69.1%) and erlotinib (12.1 months and 71.6%) were observed. In multivariate analysis toxicity was predictive for PFS and OS. In patients with adverse events (AEs) versus those without AEs, improved median PFS (13.6 months vs 8.8 months) and median OS (23.6 vs 15.5 months) were observed. Median OS in the group with AE of grades 3–4 and those with AE of grades 1–2 were 42.1 months and 23.4 months, respectively.ConclusionThis study represents the largest RWE of first-line TKI therapy in a European country with longer survival of patients receiving second-generation TKI. We confirmed in everyday practice the role of toxicity as a marker of clinical benefit.

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Local Ablative Therapy Improves Survival in Patients with Synchronous Oligometastatic NSCLC Harboring EGFR Activating Mutation Treated with First-Line EGFR-TKIs

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.06.241 ◽

2018 ◽

Vol 102 (3) ◽

pp. S93

Author(s):

Q. Xu ◽

H. Liu ◽

Y. Xu ◽

C. Zhou

Keyword(s):

First Line ◽

Ablative Therapy ◽

Local Ablative Therapy ◽

Activating Mutation ◽

Egfr Tkis

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Therapeutic Effect Of First-Line EGFR-TKIs Combined With Concurrent Cranial Radiotherapy On NSCLC Patients With EGFR Activating Mutation And Brain Metastasis: A Retrospective Study

OncoTargets and Therapy ◽

10.2147/ott.s223216 ◽

2019 ◽

Vol Volume 12 ◽

pp. 8311-8318 ◽

Cited By ~ 1

Author(s):

Ning An ◽

Haoyi Wang ◽

Ji Li ◽

Xiaoyang Zhai ◽

Wang Jing ◽

...

Keyword(s):

Retrospective Study ◽

Brain Metastasis ◽

Therapeutic Effect ◽

First Line ◽

Cranial Radiotherapy ◽

Activating Mutation ◽

Nsclc Patients ◽

Egfr Tkis

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Local Consolidative Radiation Prolongs Disease Control of Patients with Oligometastatic NSCLC Harboring EGFR Activating Mutation Treated with First-Line EGFR-TKIs

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.06.1402 ◽

2019 ◽

Vol 105 (1) ◽

pp. E494-E495

Author(s):

N. An ◽

H. Wang ◽

W. Jing ◽

H. Zhu ◽

J. Yu

Keyword(s):

Disease Control ◽

First Line ◽

Activating Mutation ◽

Egfr Tkis

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Stereotactic body radiotherapy to the lung primary lesion improves the survival of patients with non-oligometastatic NSCLC harboring EGFR activating mutation with first-line EGFR-TKIs: A real-world study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21131 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21131-e21131

Author(s):

Yongmei Liu ◽

Hao Wei ◽

Xiaojuan Zhou ◽

Hui Yang ◽

Youling Gong ◽

...

Keyword(s):

Disease Progression ◽

Real World ◽

Primary Tumor ◽

Maximal Response ◽

First Line ◽

Primary Tumors ◽

Tki Treatment ◽

Egfr Mutant ◽

Egfr Tki ◽

Egfr Tkis

e21131 Background: This study aimed to explore the clinical value of SBRT for lung primary lesions of EGFR-mutant NSCLC patients with non-oligometastatic disease during first-line EGFR-TKI treatment. Methods: Patients with stage IV EGFR-mutant NSCLC and more than five metastases at diagnosis were identified. All patients were treated with first-line EGFR-TKIs and SBRT for their primary lesions. The primary end points were the progression-free survival-1 (PFS1, time of first TKI dose relative to disease progression based on RECIST), and PFS2 (time of first TKI dose relative to disease progression after SBRT). The secondary endpoints were overall survival (OS) and safety. Results: 79 patients were enrolled, including 45 patients who received SBRT for their primary tumor at the maximal response of EGFR-TKI (the preemptive RT group) and 34 patients who received SBRT for their primary tumor after the occurrence of oligo-progression (the delayed RT group). The preemptive RT group had a significantly better median PFS1 than the delayed RT group (22.3 months vs. 12.9 months, P = 0.0031). The median PFS2 in the preemptive RT and delayed RT groups were 22.3 and 28.9 months, respectively (P = 0.17). The median OS did not differ significantly between the preemptive RT group and the delayed RT group (46.6 versus 51.3 months, P = 0.54). No severe toxicities (≥ grade 3) were recorded. Conclusions: This real-world study showed that preemptive RT to lung primary tumors is a feasible option for patients with EGFR-mutant non-oligometastatic NSCLC who had stable disease during first-line EGFR-TKI treatment, with significantly improved PFS and OS.

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P76.88 Real-World Data of Osimertinib in Patients with Metastatic EGFRm+ NSCLC who Progressed on First-Line EGFR TKIs

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.01.1145 ◽

2021 ◽

Vol 16 (3) ◽

pp. S627-S628

Author(s):

J. Ma ◽

S.H. Tan ◽

D. Yin ◽

A. Tran ◽

D. Tan ◽

...

Keyword(s):

Real World ◽

First Line ◽

Real World Data ◽

World Data ◽

Egfr Tkis

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Real-World Pattern of Treatment and Clinical Outcomes of EGFR-Mutant Non-Small Cell Lung Cancer in a Single Academic Centre in Quebec

Current Oncology ◽

10.3390/curroncol28060434 ◽

2021 ◽

Vol 28 (6) ◽

pp. 5179-5191

Author(s):

Jason S. Agulnik ◽

Goulnar Kasymjanova ◽

Carmela Pepe ◽

Manjusha Hurry ◽

Ryan N. Walton ◽

...

Keyword(s):

Lung Cancer ◽

Real World ◽

Line Treatment ◽

Second Line ◽

First Line ◽

T790m Mutation ◽

Metastatic Nsclc ◽

Egfr Mutant ◽

Egfr Tkis ◽

First Line Treatment

The discovery of EGFR tyrosine kinase inhibitors (TKI) for the treatment of EGFR mutant (EGFRm) metastatic NSCLC is regarded as a landmark in lung cancer. EGFR-TKIs have now become a standard first-line treatment for EGFRm NSCLC. The aim of this retrospective cohort study is to describe real-world patterns of treatment and treatment outcomes in patients with EGFRm metastatic NSCLC who received EGFR-TKI therapy outside of clinical trials. One hundred and seventy EGFRm metastatic NSCLC patients were diagnosed and initiated on first-line TKI therapy between 2004 and 2018 at the Peter Brojde Lung Cancer Centre in Montreal. Following progression of the disease, 137 (80%) patients discontinued first-line treatment. Moreover, 80/137 (58%) patients received second-line treatment, which included: EGFR-TKIs, platinum-based, or single-agent chemotherapy. At the time of progression on first-line treatment, 73 patients were tested for the T790M mutation. Moreover, 30/73 (41%) patients were found to be positive for the T790M mutation; 62/80 patients progressed to second-line treatment and 20/62 were started on third-line treatment. The median duration of treatment was 11.5 (95% CI; 9.62–13.44) months for first-line treatment, and 4.4 (95% CI: 1.47–7.39) months for second-line treatment. Median OS from the time of diagnosis of metastatic disease was 23.5 months (95% CI: 16.9–30.1) and median OS from the initiation of EGFR-TKI was 20.6 months (95% CI: 13.5–27.6). We identified that ECOG PS ≤ 2, presence of exon 19 deletion mutation, and absence of brain metastases were associated with better OS. A significant OS benefit was observed in patients treated with osimertinib in second-line treatment compared to those who never received osimertinib. Overall, our retrospective observational study suggests that treatment outcomes in EGFRm NSCLC in real-world practice, such as OS and PFS, reflect the result of RCTs. However, given the few observational studies on real-world treatment patterns of EGFR-mutant NSCLC, this study is important for understanding the potential impact of EGFR-TKIs on survival outside of clinical trials. Further real-world studies are needed to characterize patient outcomes for emerging therapies, including first-line osimertinib use and combination of osimertinib with chemotherapy and potential future combination of osimertinib and novel anticancer drug, outside of a clinical trial setting.

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