Real-world Treatment Patterns in Patients with EGFR Mutation-positive NSCLC Receiving a First-Line, First- or Second-generation EGFR Tyrosine Kinase Inhibitor in South Korea and Taiwan

Abstract

Introduction: The preferred first-line (1L) treatment for epidermal growth factor receptor (EGFR) mutation-positive (EGFRm) advanced/metastatic non-small lung cancer (NSCLC) are EGFR-tyrosine kinase inhibitors (TKIs). However, most patients treated with 1L first- or second-generation (1G/2G) EGFR-TKIs acquire resistance; the EGFR T790M mutation is observed in ~30–50% of patients. We report real-world NSCLC treatment and T790M testing patterns in South Korea and Taiwan. Methods: Retrospective medical record review of EGFRm advanced/metastatic NSCLC patients from routine practice. 1G/2G EGFR-TKI initiation 1 January 2015–31 December 2017 (follow-up end date: last available medical record or August 2019). Study measures: demographic/disease characteristics, 1L/2L treatment, T790M testing. Results: In South Korea, 70% (164/235) and in Taiwan 89% (89/100) experienced 1L disease progression (median [range] follow-up: 22 [2.3–50.7] months). Of those with disease progression, 68% (111/164) and 62% (55/89) had T790M testing in South Korea and Taiwan, respectively. In South Korea, 43% (48/111) were T790M-positive with 88% (n=42/48) receiving osimertinib (mostly 2L). In Taiwan, 18% (10/55) were T790M-positive; 100% received osimertinib. Overall, 73% (120/164) and 63% (63/100) in South Korea and Taiwan, respectively, received 2L therapy, predominantly pemetrexed-containing regimens. Among patients with disease progression, 9% (14/164) and 24% (21/89) died before receiving 2L therapy in South Korea and Taiwan, respectively. Conclusion: In both countries, <70% with 1L disease progression were tested for T790M at any point from NSCLC diagnosis, suggesting resistance mutation testing could be improved. Treatment/testing patterns may have changed in both countries since study initiation due to osimertinib reimbursement changes beginning December 2017.

Treatment Patterns, Clinical Outcomes and Health Care Resource Utilisation in Patients with EGFR-mutated Metastatic Non-Small Cell Lung Cancer: A Real-World Study in South Korea

“…These include the open-label, randomised, Phase 3 LUX-Lung 6 study, which compared second-generation EGFR-TKI afatinib with the gemcitabine plus cisplatin In this study, afatinib was the most frequently prescribed EGFR-TKI in the 1L setting. A similar observation was made in the real-world study by Lee et al 2021 in a cohort of 235 patients from South Korea treated between January 2015 and December 2017 [18]. However, these findings contrast from real-world observations in the USA of 782 patients who initiated 1L treatment between January 2016 and July 2019, for whom erlotinib was the most common 1L treatment [19].…”

Real-World Study of Osimertinib in Korean Patients with Epidermal Growth Factor Receptor T790M Mutation–Positive Non–Small Cell Lung Cancer

“…This study revealed that the efficacy and safety profile of osimertinib were in line with the results of the AURA3 trial. Osimertinib has been approved as a second or more line setting in EGFR T790M-positive NSCLC patients since December 2017 [ 14 ]. However, there have only been a limited number of real-world studies investigating the efficacy and safety of osimertinib in the Asian population.…”

Identification of oxazolo[4,5-g]quinazolin-2(1H)-one Derivatives as EGFR Inhibitors for Cancer Prevention

“…The ability to differentiate between a malignant and a noncancerous cell is essential to intervene in treating cancer cell progression so that the normal cells remain undisturbed. Hence, current research efforts mainly focus on developing targeted therapies on key molecules elaborate in tumor proliferation and survival (Citri and Yarden, 2006;Du et al, 2021;Lee et al, 2021). Epidermal growth factor receptors (EGFR) is one such target that has been successful in curing solid tumors (Viswanathan et al, 2019;Abeer et al, 2021;Zhang et al, 2021).…”