scholarly journals Different Survival Benefit of Osimertinib in Different Sequences: A Real‐World Outcome of Osimertinib Treatment in Pretreated T790M-Positive Advanced NSCLC in Taiwan

2021 ◽  
Author(s):  
Chin-Chou Wang ◽  
Chien-Hao Lai ◽  
Huang-Chih Chang ◽  
Chia-Cheng Tseng ◽  
Kuo-Tung Huang ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Real World ◽  
Therapy Group ◽  
Chang Gung Memorial Hospital ◽  
Line Treatment ◽  
T790m Mutation ◽  
Poor Prognostic Factor ◽  
Significant Difference ◽  
Third Line ◽  
Group B

Abstract Background: To investigate the relationships among the clinical characteristics, different EGFR-TKIs, and osimertinib treatment in different treatment lines.Methods: We retrospectively screened a total of 3807 patients diagnosed between 2013 and 2019 at Kaohsiung Chang Gung Memorial Hospital. Furthermore, 98 patients after re-biopsy or liquid with EGFR T790M mutation who received osimertinib were enrolled for analysis. Results: Among all 98 patients, the median PFS of those who received osimertinib therapy was 10.48 months, and the median OS of those who received osimertinib therapy was 42.21 months. The OS of those who received osimertinib therapy after previous gefitinib, afatinib, or erlotinib therapy was 87.93, 49.00, and 42.00 months, respectively (P=0.006). There was a significant difference in disease control rate between those who received osimertinib treatment after previous chemotherapy (Group A) or immediately following EGFR-TKI therapy (Group B) (93.3% vs. 77.4%, P=0.029). There was also a significant difference in PS between those who received osimertinib as a second-line treatment and those who received it as a third-line treatment (10.83 vs. 17.33 months, P=0.044). In addition, COPD tended to be a poor prognostic factor for PFS and OS.Conclusion: In this retrospective real‐world analysis, it was determined that pretreatment with gefitinib and previous chemotherapy could affect the treatment outcomes of NSCLC patients treated with osimertinib. Furthermore, COPD tended to a poor prognostic factor for PFS and OS in such patients.

Efficacy of weekly paclitaxel-bevacizumab combination in advanced nonsquamous non-small cell lung cancer (NSCLC): AVATAX, a retrospective multicentric study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21086-e21086
Author(s):  
Geoffroy Bilger ◽  
Anne-Claire Toffart ◽  
Marie Darasson ◽  
Michaël Duruisseaux ◽  
Lucie Ulmer ◽  
...  
Keyword(s):  
Performance Status ◽  
Objective Response ◽  
Progression Free Survival ◽  
Line Treatment ◽  
Second Line ◽  
Multicentric Study ◽  
Significant Difference ◽  
Third Line ◽  
And Performance ◽  
Line Setting

e21086 Background: With the growing role of immunotherapy (ICI) as first-line setting for advanced NSCLC, strategies must be redefined after failure. The combination paclitaxel-bevacizumab showed in the ULTIMATE trial a significant superiority versus docetaxel as second or third-line treatment. Limited restropective studies has demonstrated unexpected efficacy of chemotherapy after prior progression on ICI. This combination could be use as salvage treatment following ICI. Methods: This multi-centric retrospective study identifies patients treated with the combination paclitaxel-bevacizumab in metastatic non-squamous NSCLC as second-line therapy or beyond. Main objectives were to describe safety and efficacy of this combination, with a special attention to the sub-group treated just after ICI. Results: From January 2010 to February 2020, 314 patients started the paclitaxel-bevacizumab combination : 55% male, with a median age of 60 years, 27% with a performance status ≥2, 45% with brain metastases. A majority of patients were treated in second (20%) and third-line (39%), and 28% were treated just after ICI failure (88/314). Objective response rate (ORR) was 40% and disease control rate was 77 %. Median progression-free survival (PFS) and overall survival (OS) were 5,7 months [IQ,3,2–9,6] and 10,8 months [IQ,5,3–19,6] respectively. All grades adverse events concerned 82% of patients, including 53% asthenia and 39% neurotoxicity, and 25% of patients continued a monotherapy alone due to toxicity. Median PFS for patients treated after ICI failure (ICI+) was significantly superior compare to those not previously treated with ICI (ICI-) : 7,0 months [IQ,4,2–11,0] vs 5,2 months [IQ,2,9–8,8] p (log-rank) = 0,01. There was not statistically significant difference in term of OS between this two groups. In multivariate analysis, factors associated with superior PFS were previous ICI treatment (ICI+) and performance status. Conclusions: This study confirms an acceptable toxicity profile associated with interesting efficacy of the combination paclitaxel-bevacizumab as second-line treatment or beyond for non–squamous NSCLC patients, particularly after progression with ICI.

scholarly journals Delayed PCI 12 Hours after the Onset of Symptoms Is Associated with Improved Outcomes for Patients with ST-Segment Elevation Myocardial Infarction: A Real-World Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Wen-Juan Xiu ◽  
Hai-Tao Yang ◽  
Ying-Ying Zheng ◽  
Yi-Tong Ma ◽  
Xiang Xie
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
Time Window ◽  
Therapy Group ◽  
Trial Registration ◽  
St Segment Elevation ◽  
Medication Therapy ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Significant Difference

Background. Primary percutaneous coronary intervention (PPCI) plays a pivotal role in the treatment of ST-segment elevation myocardial infarction (STEMI). However, it remains controversial whether PCI delayed beyond the recommended time window of 12 h after the onset of symptoms is applicable to STEMI. Objective. The acute myocardial infarction (AMI) registration study in Xinjiang, China, is a real-world clinical trial (retrospective cohort study) that includes hospitalized patients. The purpose of this study was to compare delayed PCI and medication therapy beyond the recommended time window of 12 h after the onset of symptoms on the outcomes of STEMI patients. Methods and Results. From May 2012 to December 2015, a total of 1072 STEMI patients received delayed PCI (n=594) or standard medication therapy (MT) (n=478) more than 12 h after the onset of symptoms. The number of all-cause deaths in the delayed PCI group and that in the MT group were 55 (9.3%) and 138 (28.9%), respectively, and a significant difference between the groups was indicated for this variable (P<0.001). The number of cardiac deaths in the delayed PCI group and that in the medication therapy group were 47 (7.9%) and 120 (25.1%), respectively, and a significant difference between the groups was indicated for this variable (P<0.001). We also found that the MACE incidence in the delayed PCI group was significantly higher than it was in the MT group (32.2% versus 43.5%, P<0.001). Propensity score matching (PSM) analyses remained significant differences between the delayed PCI group and the MT group, respectively, in all-cause deaths (9.3% versus 25.8%, P<0.001) and cardiac death (8.7% versus 21.6%, P<0.001). Conclusion. Compared to medication therapy, PCI for STEMI delayed beyond 12 h after the onset of symptoms can better reduce mortality and the incidence of MACEs. Trial Registration. This study is registered with the following: Trial Registration: clinicaltrials.gov; Identifier: NCT02737956.

Chemoresistance Can Be Reliably Overcome with High-Dose Therapy and Autologous Stem Cell Transplantation (HDT/ASCT) for Relapsed and Refractory Hodgkin's Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2022-2022
Author(s):  
Alina S. Gerrie ◽  
Maryse M. Power ◽  
Kerry J. Savage ◽  
John D. Shepherd ◽  
Joseph M. Connors
Keyword(s):  
Prognostic Factor ◽  
Salvage Therapy ◽  
Salvage Chemotherapy ◽  
High Dose ◽  
Primary Therapy ◽  
Poor Prognostic Factor ◽  
Response To Chemotherapy ◽  
Significant Difference

Abstract Abstract 2022 Background: HDT/ASCT is the preferred treatment for relapsed and refractory HL patients (pts) with chemosensitive disease, with cure rates approximating 40–60%. The role for HDT/ASCT in chemoresistant HL is less well defined and many centers do not offer this treatment to such patients. Since 1985, HDT/ASCT has been recommended in British Columbia (BC) for all HL pts with progressive disease despite primary ABVD-type therapy, irrespective of response to salvage therapy. We sought to evaluate the long-term outcomes of HL pts whose disease was resistant to chemotherapy preceding HDT/ASCT. Methods: We reviewed all HL pts who underwent HDT/ASCT for primary progression (PP) or first relapse (1REL) after initial treatment with chemotherapy +/− radiation. Primary progression (PP) was defined as progression during or within 3 months of completion of initial therapy. Pts were considered to have: chemoresistant (R) disease = stable disease or progression on chemotherapy preceding HDT/ASCT; chemosensitive (S) disease = clinical and/or radiographic response to chemotherapy preceding HDT/ASCT; or untested (U) if no salvage chemotherapy was given. Clinical and laboratory data were obtained from the BC Cancer Agency Lymphoid Cancer Database, the Leukemia/BMT Program of BC Database and from hospital, clinic, and physician records. Results: 251 pts underwent HDT/ASCT for PP (n=90 36%) or 1REL (n=161 64%) between 1985–2011: male 53%; median age at diagnosis 28 y (range 16–59 y), at HDT/ASCT 31 y (range 31–62 y). Characteristics at diagnosis were: advanced stage(stage IIB, II bulky, III or IV) 94%; stage 3–4 60%; B symptoms 57%; bulk (≥10 cm) 42%; primary therapy: ABVD/ABVD-like, 95%; MOPP-like 5%; combined modality therapy 31%. Salvage therapy prior to HDT/ASCT included MVPP (28%); COP/COPP (22%); GDP (27%); no chemotherapy (13%); other (11%). RT was given with salvage therapy in 19%: alone, 27%; with chemotherapy, 73%. Conditioning regimen was with CBV/CBVP in the majority of cases (88%); BEAM (11%); other (1%). At a median follow-up for living pts of 8 y (range 0.2 – 25 y), 136 pts (54%) were alive free of HL; 89 pts (35%) have relapsed. For all pts, median overall (OS) and progression free survivals (PFS) were 21.7 y (95% CI 16.0–27.5) and 17.3 y (95% CI 9.8–24.8), respectively. 13 pts (5%) died of complications related to or within 1 month of HDT/ASCT, 6 (2%) from secondary malignancies, 7 (3%) from unrelated causes. 199 pts (56 PP, 143 1REL) had information available regarding response to salvage therapy. Of the 56 PP pts, 14 (25%) had chemoresistant disease (PP/R); 21 (38%) did not receive salvage therapy and thus were untested (PP/U); 21 (38%) had chemosensitive disease (PP/S). 10-y PFS for PP/R, PP/U, and PP/S groups were 27%, 24%, and 40%, respectively; 10-y OS were 53%, 27%, and 53%, respectively. Of the 143 1REL pts, 26 (18%) had chemoresistant disease (1REL/R); 12 (8%) did not receive salvage therapy (1REL/U); 105 (73%) had chemosensitive disease (1REL/S). 10-y PFS for 1REL/R, 1REL/U, and 1REL/S groups were 49%, 57%, and 58%, respectively; 10-y OS were 55%, 65%, 69%, respectively. OS and PFS for the chemoresistant groups (PP/R, PP/U, 1REL/R) and 1REL/U are shown in Figures 1A and 1B respectively. To evaluate impact of chemoresistance on outcomes, PP/R (pts resistant to both primary and salvage therapy, “double-resistant”) and PP/U pts (resistant to primary therapy, “single-resistant”) were grouped together (n=35) and compared to PP/S pts. There was a significant difference in OS (P =.05) but not PFS (P =.12). When pts with 1REL/R were compared to 1REL/S, there was no significant difference in OS (P =.25) or PFS (P =.26). Conclusion: In this large uniformly treated cohort of HL pts with long-term follow-up, chemoresistance preceding HDT/ASCT was identified as a poor prognostic factor, particularly for PP pts; however, this poor prognostic factor could be partially overcome by HDT/ASCT, resulting in cure in 25–50% of pts across all chemoresistant groups. Importantly, even pts who were double-resistant to both primary and salvage therapy were cured in 27% of cases. HDT/ASCT should therefore be considered in all transplant eligible pts, regardless of responsiveness to salvage chemotherapy. Disclosures: No relevant conflicts of interest to declare.

Exploration of patients with gastric cancer who benefit from apatinib: An updated real-world study.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Guo-ping Sun ◽  
Dongliang Li ◽  
Zhongliang Ning ◽  
Yifu He ◽  
Fenglin Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Combined Chemotherapy ◽  
Line Treatment ◽  
Open Label ◽  
Hand Foot Syndrome ◽  
Third Line ◽  
Grade 3 ◽  
Ecog Ps ◽  
Clinical Trial Information

161 Background: A real-world study to observe the efficacy and safety of apatinib treatment in clinical practice, and explored patients (pts) who could benefit from apatinib. Methods: This is an open-label, prospective, observational study, pts (age ≥ 18 yrs) with pathologically or histologically diagnosed GC who were given apatinib treatment met the inclusion criteria. Results: From September 1, 2017 to September 1, 2018. 954 pts were enrolled. 679 pts received palliative treatment were included in the analysis. 499 (73.6%) were males. The age of the pts was (63.1 ± 10.8) yrs. Pts with ECOG PS 0/1 accounted for 78.1%. Pts received first-line treatment, second-line treatment, third-line treatment or above , respectively were 42.2%, 30.5%, 27.3%. 509 (75.1%) pts were treated with apatinib at dose of 500 mg. There were 375 pts available for efficiency evaluation. Among them, 1 achieved CR, 35 achieved PR, 198 had SD, and 57 had PD, resulting in an ORR of 11.9% and a DCR of 77.4%. The mPFS is 4.2 m (95% CI: 3.5-4.8), OS data was still in follow-up. This study showed its efficacy for pts with monotherapy compared with combined chemotherapy (3.3 m vs. 5.0 m, P = 0.003). The mPFS for patients with hypertension were longer than without hypertension (7.1m vs. 3.7m, P = 0.038). And pts also had longer mPFS with good ECOG PS (0-1) compared to those with poor ECOG PS (2-4) (4.7 m vs. 2.9 m, P = 0.003). The incidence of AEs was 402 (88.2%) and the grade 3/4 treatment-related AEs was 14.7%. The most common treatment-related AEs were debilitation (31.2%), hand-foot syndrome (27.5%), hypertension (25.3%), anorexia (11.5%), diarrhea (10.3%), albumin decreased (38.5%), uric acid elevated (31.6%), and total bilirubin increased (29.1%). Conclusions: In the real world, apatinib is confirmed to be effective and safe for GC pts. Factors associated with better prognosis were apatinib combined chemotherapy, ECOG PS 0/1 and occurrence of hypertension. Further analysis is needed to identify pts who benefit from apatinib treatment. Preliminary results of the study were released in ESMO 2018 Congress (683P). Clinical trial information: NCT 03333967.

scholarly journals Survival of Patients with Epidermal Growth Factor Receptor-Mutated Metastatic Non-Small Cell Lung Cancer Treated beyond the Second Line in the Tyrosine Kinase Inhibitor Era

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3887
Author(s):  
Valéry Refeno ◽  
Michele Lamuraglia ◽  
Safae Terrisse ◽  
Clément Bonnet ◽  
Clément Dumont ◽  
...  
Keyword(s):  
Kinase Inhibitor ◽  
Growth Factor Receptor ◽  
Egfr Mutations ◽  
Line Treatment ◽  
Second Line ◽  
Saint Louis ◽  
Significant Difference ◽  
Third Line ◽  
Egfr Mutated ◽  
Third Line Treatment

Background: The identification of activating mutations in specific genes led to the development of targeted therapies for NSCLC. TKI directed against EGFR-mutations were the first to prove their major efficacy. Medical associations recommend their use as first and second-line metastatic treatments in EGFR-mutated patients. Our objective was to analyze the survival of EGFR-mutated patients treated beyond the second line of treatment. Methods: We performed a longitudinal, retrospective and analytical study at APHP (Assistance Publique Hopitaux de Paris) Saint Louis, Paris, France, from 1 January 2010 to 31 December 2020 (11 years), on EGFR-mutated patients with metastatic NSCLC which received TKI or chemotherapy (CT) in third-line. Results: Out of about 107 EGFR-mutated patients, 31 patients who benefited from TKI or CT in the third line of treatment were retained for this study. The mean age was 60.03 ± 11.93 years and the sex ratio male/female was 0.24. Mutations of exon 19, 21 and 20 were found in 21 (67.7%), 7 (22.6%) and 7 (22.6%) patients, respectively. Third-line treatment was CT for 16 patients (51.6%) and TKI for the 15 remaining patients (48.4%). Osimertinib was the most used TKI in third-line (n = 10/15; 66.67%). The median duration of third-line treatment was 5.37 months (range 0.53–37.6) and the median follow-up duration was 40.83 months (range 11.33–88.57). There was a significant difference in PFS between patients treated with TKI and CT in third-line (p = 0.028). For patients treated with CT in second-line, there was a significant difference of PFS (p < 0.001) and OS (p = 0.014) in favor of the use of TKI in third-line. Conclusions: For patients receiving CT in second-line, TKI appears to be a better alternative in third-line compared to CT. Osimertinib may be used in third line treatment if not used before.

scholarly journals Low proliferative level is a poor prognostic factor for colon adenocarcinoma

2014 ◽  
Vol 95 (3) ◽  
pp. 378-382
Author(s):  
G A Raskin ◽  
S V Petrov
Keyword(s):  
Prognostic Factor ◽  
Proliferative Activity ◽  
Single Case ◽  
Cancer Recurrence ◽  
Colon Adenocarcinoma ◽  
Tumor Stage ◽  
Ki 67 ◽  
Poor Prognostic Factor ◽  
Significant Difference ◽  
Primary Colon

Aim. To match up the proliferative activity of colon adenocarcinoma cells with tumor stage and survival rate. Methods. Ki-67 protein expression was evaluated by immunohistochemical methods in 217 patients with primary colon adenocarcinoma. After epitope retrieval and endogenous peroxidase inhibiting by 3% solution of hydrogen peroxide, histologic samples were stained by antibodies to Ki-67 protein (clone SP6, dilution 1:300) and polymer systemic detection with diaminobenzidine as a chromogenic substrate. Nuclear counterstain was performed using Mayer’s hematoxylin solution. Results. Assessment of colon adenocarcinoma proliferative activity showed a significant difference between the number of cases with high (70%) and relatively low (≤30%) proliferative levels in groups with metastatic cancers and non-metastatic tumors. In patients with no relapses, colon adenocarcinoma proliferative activity assessment showed proliferation level exceeding 70% in 21 (95%) out of 22 cases, in a single case proliferation level of 60% was found according to Ki-67, no cases of proliferation level lower than 50% was found. Statistical analysis showed that proliferative activity was significantly lower in patients with metastatic colon adenocarcinoma compared to cases of adenocarcinoma without metastases (p= 0.0019). We observe one clinical case of aggressive colon adenocarcinoma with omental, peritoneal, paraumbilical metastases in 28-year old patient, in whom proliferative activity by Ki-67 was measured as 20%. Conclusion. Low proliferative level in colon adenocarcinoma is a poor prognostic factor for possible metastasing and cancer recurrence.

scholarly journals Analisis Efektivitas Kontrol Penurunan Tekanan Darah pada Pasien Hipertensi yang Mendapat Terapi Obat Antihipertensi Golongan Angiotensin Receptor Blocker’s (Candersartan, Valsartan, Kalium Losartan)

2017 ◽  
Vol 2 (2) ◽  
pp. 9-14
Author(s):  
Ninik Mas Ulfa
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Therapy Group ◽  
Age Factors ◽  
Blood Pressure Reduction ◽  
Hypertensive Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B

ABSTRAKHipertensi adalah peningkatan tekanan darah sistolik lebih dari 140 mmHg dan tekanan darah diastolik lebih dari 90 mmHg pada dua kali pengukuran dengan selang waktu lima menit dalam keadaan cukup istirahat. Faktor penyebab hipertensi adalah faktor gaya hidup, faktor genetika dan faktor usia. Hipertensi termasuk dalam penyakit degeneratif dimana terjadi penurunan organ tubuh. Tujuan dari penelitian ini adalah untuk mengetahui efektifitas kontrol penurunan teakanan darah dari terapi obat Candersartan, Valsartan dan Kalium Losartan. Pada penelitian ini dilakukan di RS X wilayah Surabaya Selatan dan RS Y wilayah Surabaya Timur. Penelitian ini bersifat retrospektif dengan pengamatan observasioanl. Penelitian ini terbagi dalam 3 kelompok terapi dengan jumlah total populasi adalah 57 pasien. Data tekanan darah sistolik-diastolik diamati selama 5 bulan terapi darimasing-masing kelompok terapi A (Candersartan n = 19), kelompok terapi B (Valsartan n= 19), dan kelompok terapi C (Kalium Losartan n= 19).Hasil penelitian menunjukkan bahwa terjadi penurunan tekanan darah sistolik pada kelompok A sebesar 21,18%, kelompok B = 24,20%, dan kelompok C = 22,51%. Penurunan tekanan darah diastolic pada kelompok A sebesar 12,14%, kelompok B = 14,04% dan kelompok C = 10,98%. Berdasarkan hasil analisa statistik diperoleh hasil p = 0,967 > α = 0,05 yang berarti tidak ada perbedaan yang bermakna dari ketiga kelompok terapi tersebut dalam penurunan tekanan darah sistolik maupun diastolik pada pasien hipertensi. Hal ini berarti bahwa efektifitas ketiga obat tersebut dalam kontrol penurunan tekanan darah pada pasien Hipertensi mempunyai efektifitas yangKata Kunci: Candersartan, Valsartan, Kalium Losartan, HipertensiABSTRACTHypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a resting state. Factors causing hypertension are lifestyle factors, genetic factors and age factors. Hypertension is included in degenerative diseases where there is a decrease in body organs. The purpose of this study was to determine the effectiveness of blood pressure control of Candersartan, Valsartan and Potassium Losartan. This research was conducted in RS X of South Surabaya and RS Y of East Surabaya. This study is retrospective with observational. The study was divided into 3 therapeutic groups with a total population of 57 patients. Data on systolic-diastolic blood pressurewere observed for 5 months of therapy from each of the therapy groups A (Candersartan n = 19), therapy group B (Valsartan n = 19), and therapy group C (Potassium Losartan n = 19). That there was a decrease in systolic blood pressure in group A of 21,18%, group B = 24,20%, and group C = 22,51%. Diastolic blood pressure decrease in group A was 12,14%, group B = 14,04% and group C = 10,98%. Based on the results of statistical analysis obtained results p = 0.967> α = 0.05 which means there is no significant difference of the three groups of therapy in the reduction of systolic blood pressure and diastolic in hypertensive patients. This means that the effectiveness of the three drugs in the control of blood pressure reduction in hypertensive patients has the same effectiveness.Key Words: Candersartan, Valsartan, Potasium Losartan, Hypertesion

Osimertinib compared to docetaxel-bevacizumab as third-line treatment in EGFR T790M mutated non-small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9017-9017 ◽  
Author(s):  
Keke Nie ◽  
Zhongfa Zhang ◽  
Xiao Zou ◽  
Chunling Zhang ◽  
Xingjun Zhuang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Response Rate ◽  
Resistance Mutation ◽  
Progression Free Survival ◽  
Line Treatment ◽  
T790m Mutation ◽  
Free Survival ◽  
Third Line ◽  
Egfr T790m ◽  
Third Line Treatment

9017 Background: Osimertinib, an oral irreversible EGFR tyrosine kinase inhibitor, had promising results in patients with EGFR T790M resistance mutation of non-small-cell lung cancer (NSCLC). This study compared efficacy and toxicities of osimertinib versus docetaxel -bevacizumab as third-line treatment in EGFR T790M mutated NSCLC. Methods: In this phase 3, open-label, three-center study, we randomly assigned previously treated with TKI-chemotherapy or chemotherapy-TKI recurrent or metastatic advanced non-squamous lung cancer patients who had acquired EGFR T790M resistance mutation confirmed by tumor tissues or serum genetic test. Patients were randomly assigned in a ratio of 1:1 to receive oral osimertinib (80mg/day) or receive intravenous infusion docetaxel (75mg/m2) and bevacizumab (7.5mg/kg) until disease progression or unacceptable toxic effects. Docetaxel -bevacizumab group patients might crossover to osimertinib group after disease progression. The primary end-point of this study was progression-free survival and the secondary end-point were response rates, toxicities and OS. Results: A total of 147 patients were treated. Among them, 74 enrolled in the osimertinib group and 73 in the docetaxel-bevacizumab group. The median progression-free survival was 10.20 months and 2.95 months in the osimertinib group and docetaxel -bevacizumab group respectively (Hazard ratio 0.23; 95% confidence interval, 0.12 to 0.38; P < 0.0001). The overall response rate and disease control rate was 61.6% or 87.6% in osimertinib group 8.3% or 43.0% in docetaxel-bevacizumab group respectively. The median overall survival time was not reached. The main grade 3 or 4 toxic effects were diarrhea (2.7%) and interstitial lung disease (1.2%) in the osimertinib group and alopecia (15.1%), anorexia (12.3%), neutropenia (9.6%) and nausea (8.6%) in docetaxel -bevacizumab group. Conclusions: Response rate and progression-free survival of osimertinib group were superior to docetaxel-bevacizumab group in third-line treatment of EGFR T790M positive NSCLC. There was no survival difference between patients with EGFR 19 Del-T790M mutation and EGFR L858R-T790M mutation. Clinical trial information: NCT02959749.

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