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

Background

Recently FLAURA study demonstrated significant PFS and numeric OS benefit for Osimertinib 1^st line vs. 1^st gen. TKI’s Erlotinib/Gefitinib. The number of pts switching from 1^st gen. to 3^rd 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 2^nd 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 3^rd generation TKI and 104 pts after accessibility to 3^rd generation TKI.

Results

130/140 pts were treated with 1^st line TKI and 10 received 1^st line chemotherapy. 17 pts are still on 1^st line TKI, 8 pts were lost to follow-up, 3 pts died while on 1^st line TKI. 112 pts were candidates for 2^nd line therapy. 34/112 (30%) of these pts did not receive 2^nd line therapy. Causes for not receiving 2^nd 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 3^rd gen. TKI, 20 of 66 (30%) pts did not receive 2^nd line therapy. Median OS of the overall cohort was 27 months (n = 140), median OS of pts receiving 2^nd line (n = 78) vs. no 2^nd line (n = 62) was 36 vs. 14 months (p < 0.0001). After accessibility of 3^rd gen. TKI 30/104 pts (29%) receive a 3^rd gen. TKI after 1^st line or 2^nd 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 1^st or 2^nd gen. TKI do not reach 2^nd line therapy even when 3^rd gen. TKI were accessible. Reasons for not receiving 2^nd 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 1^st 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.