Abstract 117P
Background
First-line (1L) treatment options for LS RASwt mCRC include the addition of epidermal growth factor receptor inhibitors (EGFRi) to chemotherapy (CT), supported by the overall survival advantage versus CT + bevacizumab (BEV) demonstrated recently in PARADIGM, the first phase 3 trial with pre-planned analysis by tumour side. Treatment selection and outcomes in Australasian routine practice has yet to be described.
Methods
Data from 1/2015 – 5/2023 on patients with LS RASwt mCRC who received 1L doublet CT for palliative intent was reviewed from TRACC, a prospective, multi-site Australasian registry. Baseline clinicopathological characteristics and survival outcomes were analysed with p ≤0.05 denoted as statistical significance.
Results
Of 676 LS RASwt, palliative intent, mCRC patients, 573 (85%) were actively treated, 404 (60%) receiving 1L doublet CT. Of these, 193 (48%) also received EGFRi and 120 (30%) also received BEV. Compared to BEV, patients receiving 1L EGFRi trended towards younger age (57 vs 61 years, p=0.07), were more often Stage IV at diagnosis (80% vs 70%, p=0.05), and less likely to have a BRAF mutant tumour (5% vs 17%, p=0.002). Median progression-free survival (PFS) was 11.7, 9.7 and 10.9 months for EGFRi + doublet CT, BEV + doublet CT and doublet CT alone respectively (HR 0.86 [0.67-1.12], p=0.06 for EGFRi + doublet CT versus BEV + doublet CT). Median overall survival (OS) was 38.1, 29.8 and 31.0 months for EGFRi + doublet CT, BEV + doublet CT and doublet CT alone respectively (HR 0.78 [0.58-1.07], p=0.12 for EGFRi + doublet CT versus BEV). Second-line (2L) PFS was similar for initial EGFRi (n=50 patients) then BEV versus opposite (n=32 patients) sequence (9.7 vs 8.0 months, p=0.55). Notably 24% of patients did not receive an EGFRi in 1L or 2L.
Conclusions
In Australasian practice, 1 in 2 patients with LS RASwt mCRC received 1L treatment with EGFRi + doublet CT, with trends toward improved PFS and OS versus BEV + doublet CT. 1 in 4 patients never received an EGFRi in 1L or 2L treatment, with further research required to understand clinician rationale for reserving active targeted treatments to later line settings.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
WEHI.
Funding
Merck.
Disclosure
V. Wong, B.B.Y. Ma: Financial Interests, Institutional, Research Funding: Merck Serono. All other authors have declared no conflicts of interest.
Resources from the same session
497P - Sintilimab in combination with anlotinib in advanced NSCLC treated with first-line PD-1 antibodies: An open, single-arm, phase II trial
Presenter: Ying Jin
Session: Poster Display
Resources:
Abstract
498P - Frailty-adjusted life expectancy and survival in older lung cancer patients: A large-scale electronic health-record based study
Presenter: Thao Tu
Session: Poster Display
Resources:
Abstract
499P - Long-term survival and treatment (tx) patterns after first-line (1L) osimertinib in patients (pts) with epidermal growth factor receptor (EGFR) mutation-positive (m) advanced non-small cell lung cancer (NSCLC): Japanese cohort of a global real-world (rw) observational study
Presenter: Daichi Fujimoto
Session: Poster Display
Resources:
Abstract
500P - The effectiveness and safety of durvalumab after chemoradiotherapy for locoregional recurrence of completely resected non-small cell lung cancer: Real-world, multicenter, observational study (NEJ056)
Presenter: Hidehito Horinouchi
Session: Poster Display
Resources:
Abstract
501P - One-year survival outcomes of unresectable stage III non-small cell lung cancer patients who underwent PD-1 inhibitor plus chemo as induction therapy
Presenter: Xin Wang
Session: Poster Display
Resources:
Abstract
502P - Impact of sarcopenia on the outcome of patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy followed by durvalumab
Presenter: Kentaro Tamura
Session: Poster Display
Resources:
Abstract
503P - Clinical outcomes by infusion timing of immune checkpoint inhibitors in patients with locally advanced NSCLC
Presenter: TSUYOSHI HIRATA
Session: Poster Display
Resources:
Abstract
504P - Real-world outcomes with induction systemic therapy for stage III in eligible for upfront local therapy: Pre vs post immunotherapy era in a tertiary referral centre
Presenter: Praveen Kumar Marimuthu
Session: Poster Display
Resources:
Abstract
505P - Neoadjuvant PD-1 inhibitor (tislelizumab) plus platinum–etoposide in patients with limited-stage small cell lung cancer: A phase II trial
Presenter: Junjie Hu
Session: Poster Display
Resources:
Abstract
506P - Intrathoracic progression is still the most dominant failure pattern after first-line chemo-immunotherapy in extensive-stage small-cell lung cancer: Implications for thoracic radiotherapy
Presenter: Byoung Hyuck Kim
Session: Poster Display
Resources:
Abstract