A real world analysis of first line treatment of advanced EGFR mutated non-small cell lung cancer: A multi-center, retrospective study

Abstract

Introduction The recently published FLAURA trial demonstrated that osimertinib has remarkable efficacy in front-line setting for non-small cell lung cancer (NSCLC). While this has transformed current practice, there are no effective treatments following progression on osimertinib. The aim of our study was to compare progression-free survival (PFS) and overall survival (OS) between patients initiated on osimertinib to those started on other EGFR TKIs. Methods This was a multicenter, retrospective study conducted at two large academic centers. Adult patients with EGFR-mutated non-small cell lung cancer (NSCLC) who received EGFR therapy between 2014 and 2019 were included. Patients were dichotomized based on front-line TKI (osimertinib vs. other). PFS, OS, and time-to-discontinuation were evaluated. Results One-hundred seventy-two patients were included in the final analysis. Fifty-two (30.2%) patients received osimertinib and 120 (69.8%) patients received another EGFR TKI. The PFS rates at 6, 12, and 18 months were 86.3%, 79.5%, 69.8% in the osimertinib group and 86.6%, 64.2%, 39.3% in the other EGFR TKI group, respectively (p < 0.0036).Estimated OS at 6, 12, and 18 months was similar for both groups: 94.2%, 94.2%, 80.2% and 95.7%, 93.9%, 84.1%, respectively [Adjusted HR = 0.95 (95% CI, 0.37–2.44; p < 0.9128]. Conclusion Osimertinib demonstrated greater 12 and 18 month PFS compared to other EGFR TKIs. This finding is consistent with results of the FLAURA trial. However, unlike FLAURA, there were no differences in estimated OS between the two groups in our study. Further research to evaluate optimal sequencing strategies in the real world of first, second and third generation TKIs is needed.

Real‐world treatment patterns of metastatic non‐small cell lung cancer patients receiving epidermal growth factor receptor tyrosine kinase inhibitors

“…Among these patients, 2L osimertinib monotherapy was most common (58.3%–60.7%), followed by other EGFR TKIs (28.6%–30.1%), and chemotherapy alone or chemotherapy plus IO therapy (6.0%–7.5%). The frequency of 2L osimertinib is similar to the findings from a recently published retrospective multi‐center study using data from 2014 to 2019 which also reported that osimertinib was the most common 2L treatment option after 1L earlier generation EGFR TKIs, with 65.8% of patients progressing on other EGFR TKI and osimertinib accounting for 55.7% of subsequent treatments 33 . However, the frequencies of 2L osimertinib and chemotherapy contrast with the treatment patterns observed in previously published data reported from clinical trials and real‐world settings; those studies generally reported lower frequencies of 2L osimertinib and higher frequencies of chemotherapy, which may be a reflection of the study periods ending pre‐2018 34,35 …”

“…The frequency of 2L osimertinib is similar to the findings from a recently published retrospective multi-center study using data from 2014 to 2019 which also reported that osimertinib was the most common 2L treatment option after 1L earlier generation EGFR TKIs, with 65.8% of patients progressing on other EGFR TKI and osimertinib accounting for 55.7% of subsequent treatments. 33 However, the frequencies of 2L osimertinib and chemotherapy contrast with the treatment patterns observed in previously published data reported from clinical trials and real-world settings; those studies generally reported lower frequencies of 2L osimertinib and higher frequencies of chemotherapy, which may be a reflection of the study periods ending pre-2018. 34,35 The key strengths of this study include the use of linked large pharmacy and medical claims databases which allow for a comprehensive view of treatment patterns.…”

Real-World Testing Practices, Treatment Patterns and Clinical Outcomes in Patients from Central Eastern Europe with EGFR-Mutated Advanced Non-Small Cell Lung Cancer: A Retrospective Chart Review Study (REFLECT)

“…While our analysis is the first across the CEE region documenting the clinical outcomes and attrition rates on 1L 1G/2G EGFR TKIs, it brings evidence applicable only to the pre-FLAURA era. The preliminary reports of the first real-world studies with front-line osimertinib in advanced/metastatic EGFRm NSCLC are in line with the improved survival data reported in randomized clinical studies [ 34 , 35 ]. The median rwPFS on 1L 1G/2G EGFR TKIs recorded across the CEE cohort was of 14.0 months, being slightly higher than in the primary REFLECT study, where it was 12.6 months [ 24 ].…”

Clinical Outcomes, Treatment and Testing Patterns in Patients with Advanced Non-Small Lung Cell Cancer with Epidermal Growth Factor Receptor Mutations: Results of the Romanian Cohort From a Multi-national Retrospective Chart Review (REFLECT)

“…The first real-world studies also showed improved results with osimertinib in 1L. For example, in a retrospective analysis (28) including 172 patients with EGFRm NSCLC, the 12-and 18month PFS was greater for osimertinib versus 1G/2G EGFR TKIs (80% and 70% vs. 64% and 39%, respectively, p<0.0036). The first prospective study exploring 1L osimertinib in 126 patients with advanced EGFRm NSCLC in real-life setting (29) showed median PFS of 18.9 months, median time to discontinuation 25.3 months and median OS not reached.…”