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
313P - Immunotherapy application for advanced cancers: One institution experiences since 2016 to 2019
Presenter: Jo Pai Chen
Session: Poster display session
Resources:
Abstract
314P - An EGF motif of Del1 inhibits efficient angiogenesis and suppresses tumour growth in vivo
Presenter: Hisataka Kitano
Session: Poster display session
Resources:
Abstract
315P - Inhibition of JAK1 sensitizes human head and neck cancer cells to cetuximab
Presenter: James Bonner
Session: Poster display session
Resources:
Abstract
316TiP - Neoadjuvant and adjuvant pembrolizumab (pembro) plus standard of care (SOC) in patients (pts) with resectable locally advanced (LA) head and neck squamous cell carcinoma (HNSCC): The phase III KEYNOTE-689 study
Presenter: Ezra Cohen
Session: Poster display session
Resources:
Abstract
322P - Three-year overall survival update from the PACIFIC trial
Presenter: Yi-Long Wu
Session: Poster display session
Resources:
Abstract
323P - Novel tumour mutation score versus tumour mutation burden in predicting survival after immunotherapy in pan-cancer from MSK-IMPACT cohort
Presenter: Yuan Li
Session: Poster display session
Resources:
Abstract
324P - A novel anti-PD-1 antibody HLX10 study led to the initiation of combination immunotherapy
Presenter: Tsu Yi Chao
Session: Poster display session
Resources:
Abstract
325P - Association between immune-related adverse events and efficacy of immune checkpoint inhibitors in patients with advanced hepatocellular carcinoma
Presenter: Lawrence Wong
Session: Poster display session
Resources:
Abstract
326P - Autologous V gamma 9 V delta 2 T cell therapy to target Epstein Barr Virus (EBV)-related malignancies
Presenter: Esdy Rozali
Session: Poster display session
Resources:
Abstract
327P - Neoantigen profile of hepatocellular carcinoma reveals its correlation with tumour progression and clonal evolution
Presenter: Xiaolong Liu
Session: Poster display session
Resources:
Abstract