A population-based study describing characteristics, survival and the effect of TKI treatment on patients with EGFR mutated stage IV NSCLC in the Netherlands

Berge, D.M.H.J. ten; Aarts, Mieke J.; Groen, Harry J.M.; Aerts, Joachim; Kloover, Jeroen S.

doi:10.1016/j.ejca.2022.01.038

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…More recently, according to the Annual quality reports for lung cancer in Norway, testing rate for EGFR mutations was 74.8% in 2017, 84.6% in 2018, 84.2% in 2019, and 84.4% in 2020 ( 7 , 8 , 17 , 18 ). Although the prevalence of EGFR -mutations is reported to vary in different studies and populations, we expect the proportion of unknown EGFRm+ patients to be low, as the proportions given in Table 1 is in line with the proportion of EGFRm+ NSCLC patients in comparable, European populations ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 70%

Improvements in survival for patients with stage IV adenocarcinoma in the lung, diagnosed between 2010 – 2020 - A population-based registry study from Norway

Børø

Thoresen²,

Helland

2022

Front. Oncol.

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ObjectivesWe investigated how the prognosis for Norwegian patients with stage IV, adenocarcinoma (NSCLC) has developed during the last decade, to observe if increased survival coincides with the introduction of immunotherapy at a population level.Materials and methodsIncidence data from the Cancer Registry of Norway are virtually complete and includes information about histological subtypes and biomarkers. The data was used to analyze median and relative survival for females and males diagnosed with stage IV NSCLC, divided by histological subgroups and age-groups.ResultsDuring 2010 – 2020, 14472 patients were diagnosed with lung cancer in stage IV, in Norway. Among them 6351 patients (43%) were classified with adenocarcinoma. The median survival has increased for both sexes, but the largest increase is seen in females. From 2010 to 2020, median survival for females in the 0-69 group increased from 6.7 months to 12 months and from 3.7 months to 10 months for the 70+ age group. For the equivalent male age groups, we see an increase from 6.1 months to 7.7 months for the 0-69 group, and an increase from 3.8 months to 4.5 months for the 70+ group. When excluding patients with EGFR/ALK mutations from the survival analysis, the groups continue to display an increased survival from 2010 to 2020, although modest in the male 70+ group. The 1-year relative survival (RS) has increased for both sexes, from 32.4% to 51.2 in females and 25.4% to 44.5% in males. When EGFR/ALK positive patients were excluded from the analysis 1-year RS in females rose from 32.4% to 47.4% and for males from 25.4% to 41.8%.ConclusionA real-world patient population of stage IV, NSCLC adenocarcinoma have had a clinically meaningful increase in both median and relative survival from 2010 – 2020. The steepest survival increase has taken place after 2016, the time point where immunotherapy was implemented as a treatment option for the stage IV, adenocarcinoma population not harboring targetable mutations (EGFR/ALK).

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Section: Discussionmentioning

confidence: 70%

Improvements in survival for patients with stage IV adenocarcinoma in the lung, diagnosed between 2010 – 2020 - A population-based registry study from Norway

Børø

Thoresen²,

Helland

2022

Front. Oncol.

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“…Roughly, half of all lung cancer patients are diagnosed at stage IV, when the 1‐year survival probability is as little as 17% 1,2 . With the gradual introduction of breakthrough palliative treatments like precision medicine (i.e., targeted therapies in 2010 and immunotherapy in 2015), 3,4 survival trends are expected to rise in the overall and advanced (i.e., locally advanced or metastatic) lung cancer populations 5,6 . However, survival improvements in socioeconomically, sociodemographically, or geographically disadvantaged subpopulations may not necessarily occur at the same pace as in advantaged subpopulations.…”

Section: Introductionmentioning

confidence: 99%

“…1 , 2 With the gradual introduction of breakthrough palliative treatments like precision medicine (i.e., targeted therapies in 2010 and immunotherapy in 2015), 3 , 4 survival trends are expected to rise in the overall and advanced (i.e., locally advanced or metastatic) lung cancer populations. 5 , 6 However, survival improvements in socioeconomically, sociodemographically, or geographically disadvantaged subpopulations may not necessarily occur at the same pace as in advantaged subpopulations. Despite a universal healthcare system providing free health services at the point of care for medically necessary treatments in all provinces, there is growing evidence of social inequalities in outcomes along the cancer control continuum in Canada.…”

Section: Introductionmentioning

confidence: 99%

Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high‐resolution population‐level analysis

et al. 2023

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Background: Advanced lung cancer patients exposed to breakthrough therapies like EGFR tyrosine kinase inhibitors (EGFR-TKI) may experience social inequalities in survival, partly from differences in care. This study examined survival by neighborhood-level socioeconomic and sociodemographic status, and geographical location of advanced lung cancer patients who received gefitinib, an EGFR-TKI, as first-line palliative treatment. Differences in the use and delay of EGFR-TKI treatment were also examined. Methods:Lung cancer patients receiving gefitinib from 2001 to 2019 were identified from Quebec's health administrative databases. Accounting for age and sex, estimates were obtained for the median survival time from treatment to death, the probability of receiving osimertinib as a second EGFR-TKI, and the median time from biopsy to receiving first-line gefitinib.Results: Among 457 patients who received first-line treatment with gefitinib, those living in the most materially deprived areas had the shortest median survival time (ratio, high vs. low deprivation: 0.69; 95% CI: 0.47-1.04). The probability of receiving osimertinib as a second EGFR-TKI was highest for patients from immigrant-dense areas (ratio, high vs. lowdensity: 1.95; 95% CI: 1.26-3.36) or from Montreal (ratio, other urban areas vs. Montreal: 0.39; 95% CI: 0.16-0.71).The median wait time for gefitinib was 1.27 times longer in regions with health centers peripheral to large centers in Quebec or Montreal in comparison to regions with university-affiliated centers (95% CI: 1.09-1.54; n = 353). Conclusion:This study shows that real-world variations in survival and treatment exist among advanced lung cancer patients in the era of breakthrough therapies and that future research on inequalities should also focus on this population.

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“…All patients with advanced adenocarcinoma undergo routine genetic testing for clinically targetable genomic alterations ( 3 ). Clinical targeted therapy is imperative for NSCLC patients with epidermal growth factor receptor (EGFR) mutation ( 4 , 5 ). EGFR-targeting tyrosine kinase inhibitors (TKIs), such as gefitinib, erlotinib, and osimertinib, extend median progression-free survival (PFS) and overall survival (OS) in NSCLC patients with EGFR mutations ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics, Co-Mutations, and Treatment Outcomes in Advanced Non-Small-Cell Lung Cancer Patients With the BRAF-V600E Mutation

Shen

et al. 2022

Front. Oncol.

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BackgroundLimited treatment outcome data is available for advanced non-small cell lung cancer (NSCLC) patients with BRAF V600E mutations. In this multicenter study, we describe therapeutic options and survival outcomes for patients with mutated BRAF V600E.MethodThis was a retrospective study in which BRAF V600E-mutated advanced NSCLC patients were retrospectively recruited between January 2015 and December 2021 and had their clinical characteristics, co-mutations, and treatment efficacy assessed.ResultsFifty-three patients with BRAF V600E-mutant advanced NSCLC were included in the study, of which 64.2% were non-smokers, and the BRAF V600E mutation was more prevalent in men (52.8%). In addition, 96.2% of the patients had adenocarcinoma, and most (96.2%) received first-line therapy (23.5% anti-BRAF), with a progression-free survival (PFS) and overall survival (OS) of 10.0 [95% confidence interval (CI): 1.5–36.0 months] and 24.0 months [95% CI: 3.0–53.0 months], respectively. Twenty-three patients (43.4%) received second-line treatment (39.1% anti-BRAF), and PFS and OS were 5.0 [95% CI: 1.0–21.0 months] and 13.0 months [95% CI: 1.5–26.0 months], respectively. BRAF and MEK-targeted therapy (dabrafenib plus trametinib) produced longer PFS compared with that of chemotherapy with or without bevacizumab as a first-line (NA vs. 4.0 months, P = 0.025) or second-line therapy (6.0 vs. 4.6 months, P = 0.017). NSCLC patients harboring driver oncogene mutations such as BRAF V600E, EGFR, or ALK should be treated using targeted therapies. Concurrent TP53 mutations were the most common, affecting 11.3% (n = 6) of the patients, followed by EGFR 19 Del (n = 5). Patients with concurrent mutations had shorter PFS (9.0 vs. 10.0 months, P = 0.875) and OS (14.0 vs. 15.0 months, P = 0.555) than those without these mutations.ConclusionThese results suggest that combined BRAF- and MEK-targeted therapy is effective in BRAF V600E-mutated advanced NSCLC patients. Dabrafenib and trametinib re-challenge is also an option for patients with BRAF V600E-mutated NSCLC.

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A population-based study describing characteristics, survival and the effect of TKI treatment on patients with EGFR mutated stage IV NSCLC in the Netherlands

Cited by 6 publications

References 34 publications

Improvements in survival for patients with stage IV adenocarcinoma in the lung, diagnosed between 2010 – 2020 - A population-based registry study from Norway

Improvements in survival for patients with stage IV adenocarcinoma in the lung, diagnosed between 2010 – 2020 - A population-based registry study from Norway

Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high‐resolution population‐level analysis

Clinical Characteristics, Co-Mutations, and Treatment Outcomes in Advanced Non-Small-Cell Lung Cancer Patients With the BRAF-V600E Mutation

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