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Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

2391 - Risk of not receiving 2nd line therapy is high in EGFR mt+ pts: Real world data of certified lung cancer centers on treatment sequence in EGFR mt+ pts

Date

20 Oct 2018

Session

Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

Presenters

Julia Roeper

Citation

Annals of Oncology (2018) 29 (suppl_8): viii493-viii547. 10.1093/annonc/mdy292

Authors

J. Roeper1, M. Falk2, S. Schatz2, M. Tiemann2, C. Wesseler3, G. Wiest3, S. Sackmann4, D. Ukena4, L.C. Heukamp5, F. Griesinger6

Author affiliations

  • 1 University Department Internal-medicine-oncology, Pius Hospital Oldenburg, University of Oldenburg, 26121 - Oldenburg/DE
  • 2 Molecular Pathology, Hematopathology Hamburg, 22547 - Hamburg/DE
  • 3 Department Of Oncology, Asklepios Klinik Harburg, 21075 - Hamburg/DE
  • 4 Department Of Pneumology, Klinikum Bremen-Ost, Bremen/DE
  • 5 Molecular Pathology, NEO New Oncology, Köln/DE
  • 6 University Department Internal Medicine-oncology, Pius Hospital Oldenburg, University of Oldenburg, 26121 - Oldenburg/DE
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Resources

Abstract 2391

Background

Recently FLAURA study demonstrated significant PFS and numeric OS benefit for Osimertinib 1st line vs. 1st gen. TKI’s Erlotinib/Gefitinib. The number of pts switching from 1st gen. to 3rd gen. TKI (30%) appeared to be low and it is questionable whether these data represent real world sequencing treatment patterns. Therefore, we investigated the sequence pattern, i.e. the percentage of 2nd line therapy in EGFR mt+ pts in 3 certified lung cancer centers in Germany.

Methods

Data of 912 of 1477 pts tested for EGFR mutations were analyzed between 2009-2017. 140/144 pts with an activating EGFR mt + (16%) and treated with systemic therapy (4 pts received no therapy) were identified and their treatments were captured as well as their outcome. 36 pts were treated before accessibility to 3rd generation TKI and 104 pts after accessibility to 3rd generation TKI.

Results

130/140 pts were treated with 1st line TKI and 10 received 1st line chemotherapy. 17 pts are still on 1st line TKI, 8 pts were lost to follow-up, 3 pts died while on 1st line TKI. 112 pts were candidates for 2nd line therapy. 34/112 (30%) of these pts did not receive 2nd line therapy. Causes for not receiving 2nd line therapy were pts refusal (n = 2), bad PS (n = 26) frequently due to CNS metastases, fast progression and death (n = 6). After accessibility of 3rd gen. TKI, 20 of 66 (30%) pts did not receive 2nd line therapy. Median OS of the overall cohort was 27 months (n = 140), median OS of pts receiving 2nd line (n = 78) vs. no 2nd line (n = 62) was 36 vs. 14 months (p < 0.0001). After accessibility of 3rd gen. TKI 30/104 pts (29%) receive a 3rd gen. TKI after 1st line or 2nd line therapy. Median OS of pts receiving (n = 30) and not receiving 3rd gen. TKI (n = 110) was 55 months vs. 22 months (p < 0.0001).

Conclusions

In real world, a significant number of pts treated with 1st or 2nd gen. TKI do not reach 2nd line therapy even when 3rd gen. TKI were accessible. Reasons for not receiving 2nd line therapy are in most cases deterioration of PS and lack of possibility to test for T790M in the minority of cases (n = 28/66, 42% were not tested). These data, although favorable for the small and very selected cohort of pts treated with Osimertinib, might argue for the most effective therapy in 1st line for pts with EGFR mt+ tumors.

Clinical trial identification

Legal entity responsible for the study

Carl von Ossietzky University Oldenburg Department of Internal Medicine-Oncology.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

J. Roeper: Advisory boards: Roche, Boehringer Ingelheim. M. Falk: Advisory boards: Boehringer Ingelheim, Pfizer, Roche. M. Tiemann: Advisory boards: Novartis, Boehringer-Ingelheim, Roche, AstraZeneca; Scientific support: Novartis. F. Griesinger: Advisory boards: Ariad, AstraZeneca, Boehriger-Ingelheim, Bristol-Myers Squibb, Celegene, Clovis, Lilly, Merck-Sharp-Dome, Novartis, Roche; Travel support: Ariad, AstraZeneca, Boehriger Ingelheim, Bristol-Myers Squibb, Celegene, Clovis, Lilly, Merck-Sharp-Dome, Novartis, Pfizer, oche; Scientific support: Ariad, AstraZeneca, Boehriger Ingelheim, Bristol-Myers Squibb, Celegene, Clovis, Lilly, Merck-Sharp-Dome, Novartis, Pfizer, Roche. All other authors have declared no conflicts of interest.

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