Abstract 490P
Background
EGFR T790M mutations have been reported to occur in about 50% of patients (pts) at progression on 1st/2nd generation EGFR TKI therapy. These pts benefit from treatment with 3rd generation EGFR TKI osimertinib. However, observational real-world studies show that the proportion of pts receiving 2nd line osimertinib is lower than expected. We aimed to evaluate these treatment patterns and outcomes in our institution.
Methods
In this prospective observational study, survival, response and treatment data was collected from pts with EGFR mutant advanced NSCLC who received EGFR TKIs in the 1st line, who were treated in our institution from September 2012 to December 2017. Institutional approval was obtained and all patients provided written, informed consent.
Results
108 pts (median age 65 years, 54% females, 75% never smokers, 54% EGFR exon 19 deletion) were enrolled of whom 48 (44%) received gefitinib, 38 (35%) erlotinib and 22 (20%) afatinib in the 1st line. The median overall survival (OS) was 33.1 months (95% CI 24.5-41.7) and median progression free survival (PFS) was 11.1 months (95% CI 8.5-13.7). 83 pts (77%) had progressed at the time of analysis, and 48/83 patients (58%) underwent T790M testing. Of these, 25/48 (52%) were T790M positive. 21/83 pts went on to receive osimertinib in the 2nd line (25% of all patients who progressed on 1st line therapy)- OS was not reached in these pts. 12/83 pts received 2nd line chemotherapy (15%); 32/83 pts (39%) did not receive any 2nd line treatment. OS was 42.3 months (95% CI 24.2-50.4) and 18.2 months (95% CI 11.6-24.7) in these groups respectively.
Conclusions
In this prospective real-world study, a significant proportion of patients did not receive 2nd line therapy after progression on 1st/2nd generation TKIs. The rates of T790M mutations when tested was comparable to that reported in the literature. Some reasons for not receiving 2nd line therapy included low testing rates for EGFR T790M and patient fitness for 2nd line therapy. This suboptimal use of osimertinib in the 2nd line setting, together with favourable PFS data for osimertinib in the 1st line, favours the upfront use of osimertinib.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
C.S. Tan: Honoraria (self): AstraZeneca; Honoraria (self): Merck; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Novartis; Honoraria (self): Eli-Lilly; Honoraria (self): Eisai; Honoraria (self): BMS. R.A. Soo: Honoraria (self), Research grant / Funding (self): AstraZeneca; Honoraria (self): BMS; Honoraria (self), Research grant / Funding (self): Boehringer Ingelheim; Honoraria (self): Celgene; Honoraria (self): Ignyta; Honoraria (self): Lilly; Honoraria (self): Merck; Honoraria (self): Novartis; Honoraria (self): Pfizer; Honoraria (self): Roche; Honoraria (self): Taiho; Honoraria (self): Takeda; Honoraria (self): Yuhan. All other authors have declared no conflicts of interest.
Resources from the same session
258P - Assessment of sexual health in patients treated for ovarian cancer
Presenter: Renu Madan
Session: Poster display session
Resources:
Abstract
259P - The BOT patients fail to benefit from surgical staging procedures in prognosis and fertility outcomes: A retrospective analysis
Presenter: Li Na
Session: Poster display session
Resources:
Abstract
260P - Malignant ovarian germ cell tumours (MOGCT): Treatment results of 149 pts
Presenter: Dzhennet Chekini
Session: Poster display session
Resources:
Abstract
261P - Ovarian germ cell tumours - challenges and outcomes from a tertiary care centre in South India
Presenter: Vishnu Sreedath
Session: Poster display session
Resources:
Abstract
262P - Gestational trophoblastic tumours: Experience of the medical oncology department Hassan II University Hospital-Morocco about 29 cases
Presenter: Karima Oualla
Session: Poster display session
Resources:
Abstract
263TiP - ATHENA (GOG-3020/ENGOT-ov45): A randomised, double-blind, placebo-controlled phase III study of the poly (ADP-ribose) polymerase (PARP) inhibitor rucaparib + the PD-1 inhibitor nivolumab following frontline platinum-based chemotherapy in ovarian cancer
Presenter: Keiichi Fujiwara
Session: Poster display session
Resources:
Abstract
264TiP - ENGOT-ov43/KEYLYNK-001: A phase III trial of pembrolizumab plus chemotherapy with olaparib maintenance for first-line treatment of BRCA¬-nonmutated advanced epithelial ovarian cancer
Presenter: Keiichi Fujiwara
Session: Poster display session
Resources:
Abstract
265TiP - KEYNOTE-826: A phase III randomized study of chemotherapy with or without pembrolizumab for first-line treatment of persistent, recurrent, or metastatic cervical cancer
Presenter: Keiichi Fujiwara
Session: Poster display session
Resources:
Abstract
271P - Comparison between CHOP like regimens and DAEPOCH with or without Rituximab in adult high grade B cell lymphoma NOS; A retrospective study from a tertiary cancer hospital in South India
Presenter: LALATENDU MOHARANA
Session: Poster display session
Resources:
Abstract
272P - Melatonin increases the chemosensitivity of diffuse large Bell lymphoma cells to Epirubicin by inhibiting P-glycoprotein expression via the NF-κB pathway
Presenter: Xiuhua Sun
Session: Poster display session
Resources:
Abstract