Treatment Patterns and Clinical Outcomes in Patients With EGFR-Mutated Non-Small-Cell Lung Cancer After Progression on Osimertinib - PubMed (original) (raw)

Multicenter Study

. 2025 Jan;26(1):9-17.e3.

doi: 10.1016/j.cllc.2024.09.006. Epub 2024 Sep 23.

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Multicenter Study

Treatment Patterns and Clinical Outcomes in Patients With EGFR-Mutated Non-Small-Cell Lung Cancer After Progression on Osimertinib

Nathaniel D Robinson et al. Clin Lung Cancer. 2025 Jan.

Abstract

Introduction: For patients with advanced epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) who progress on first-line osimertinib, the optimal second-line treatment regimen after progression is not known. We sought to assess practice patterns and evaluate the association between different therapies and survival in patients with EGFR-mutated NSCLC following progression on first-line osimertinib.

Methods: Retrospective cohort study of patients who received first-line treatment with osimertinib using a population-based, multicenter nationwide electronic health record-derived deidentified database.

Results: We identified 2373 patients who received first-line osimertinib. The majority (n = 2279) received osimertinib monotherapy. A total of 538 patients received first-line osimertinib and had second-line treatment data available. Second-line treatment regimens were varied: 65% (n = 348) included chemotherapy, 37% (n = 197) included an immune checkpoint inhibitor (ICI), and 44% (n = 234) included an EGFR tyrosine kinase inhibitor (TKI). We then analyzed the 333 patients with performance status 0-2 who received chemotherapy with osimertinib (n = 107, 32%) versus chemotherapy without osimertinib (n = 226, 68%). The continuation of osimertinib with chemotherapy was associated with superior progression-free survival (PFS; median: 10.1 versus 5.9 months, Hazard Ratio [HR]: 0.48, 95% Confidence Interval [CI]: [0.34, 0.68], P < .001) and overall survival (OS; median: 17.0 versus 12.8 months, HR: 0.64, 95% CI: [0.44, 0.93], P = .018) compared to other chemotherapy approaches without osimertinib. This effect was most pronounced in patients with an EGFR exon 19 deletion.

Conclusions: Following progression on osimertinib, a wide variety of treatment regimens were used. The continuation of osimertinib with chemotherapy in the second line was associated with increased PFS and OS.

Keywords: Acquired resistance; Chemotherapy; NSCLC; Non-small cell lung cancer; Targeted therapy.

Copyright © 2024. Published by Elsevier Inc.

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Conflict of interest statement

Disclosure The authors report the following potential conflicts of interest and additional funding sources, none of which are related to the currently presented manuscript: Dr Boffa has received experimental services without charge from Epic Sciences, and was paid to attend a panel discussion in May of 2022 by Iovance. Dr Goldberg has received research funding from AstraZeneca, Boehringer Ingelheim, and Mirati. She is a consulting/advisory board member for AstraZeneca, Boehringer Ingelheim, Bristol–Myers–Squibb, Genentech, Amgen, Blueprint Medicine, Sanofi Genzyme, Daiichi-Sankyo, Takeda, Janssen, Summit Therapeutics, Merck, Regeneron, and Eli Lilly. The remaining authors have no conflicts of interest to disclose.

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