484P - Treatment (tx) patterns and outcomes in resectable early-stage EGFR-mutated (EGFRm) NSCLC in South Korea: Subgroup analysis of a global real-world (rw) study

Background

In South Korea, tx for patients (pts) with stage I–IIIA NSCLC is resection, ± systemic tx for stage II and select stage III disease. Osimertinib is a 3rd-generation EGFR-TKI approved as adjuvant tx for resected stage IB–IIIA EGFRm NSCLC, based on ADAURA trial results. To understand rw data prior to adjuvant osimertinib approval, we report EGFR mutation types, tx patterns / outcomes from the South Korean cohort of a global retrospective rw study.

Methods

Medical records of eligible pts (≥18 years [yrs] with resected stage IA–IIIA NSCLC and a positive EGFRm test result, diagnosed between 01 Jan 2014–‍31 Dec 2017), were assessed from diagnosis (Dx) until last follow-up/death or 31 Dec 2020. Primary objectives included: EGFR mutation type and frequency, tx patterns and overall survival (OS). Site of first recurrence was a secondary objective.

Results

Of 200 pts in South Korea with EGFRm NSCLC, 95 (48%) had Ex19del and 87 (44%) L858R. At Dx, median age was 62 yrs (range: 36–83), 133 pts (67%) were female, 145 (73%) were never smokers; 68 pts (34%) had stage IA disease, 43 (22%) IB, 20 (10%) IIA, 15 (8%) IIB, and 54 (27%) IIIA. In total, 90 pts (45%) received surgery only; 74 (37%) had surgery + adjuvant tx only; 22 (11%) had neoadjuvant + surgery + adjuvant tx; 14 (7%) had salvage/post-recurrence tx (see Table). After median follow-up of 54.7 months from Dx (IQR 44.5–‍70.1), 5-yr OS was 69% (96% in stage IA, 84% IB, 72% IIA, 73% IIB, 26% IIIA). Of 106 pts who received systemic tx with first recurrence data available, 53 had metastatic recurrence, most commonly in the lung (19/53; 36%) and brain (18/53; 34%).

Conclusions

In this rw study of pts in South Korea with resected EGFRm early-stage NSCLC (Dx 2014–2017), 45% of pts received surgery only and <50% received surgery + adjuvant/neoadjuvant tx; 5-yr OS was suboptimal at 69%. Early Dx and EGFR mutation testing are needed to ensure eligible pts have access to suitable adjuvant tx to improve clinical outcomes. Table: 484P

Percentages may equal to >100% as patients could have received >1 type of systemic treatment. *No patients received neoadjuvant treatment only.

Clinical trial identification

Editorial acknowledgement

The authors would like to acknowledge Rachel Gater, PhD, of Ashfield MedComms, an Inizio Company, for medical writing support that was funded by AstraZeneca in accordance with Good Publications Practice (GPP) guidelines (https://www.ismpp.org/gpp-2022).

Legal entity responsible for the study

AstraZeneca.

Funding

AstraZeneca.

Disclosure

M. Ahn: Financial Interests, Personal, Other, Honoraria: AstraZeneca; Financial Interests, Personal, Advisory Board, Honoraria: Bristol Myers Squibb, Merck Sharp & Dohme, Ono Pharmaceutical Co., Ltd., Roche; Financial Interests, Personal, Speaker, Consultant, Advisor: Alpha Pharmaceutical, AstraZeneca, Bristol Myers Squibb, Merck Sharpe & Dohme, Ono Pharmaceutical Co. Ltd., Roche, Takeda. J.H. Kang: Financial Interests, Personal, Advisory Board: Daiichi Sankyo, Boehringer Ingelheim, AstraZeneca, Novartis, Yuhan Corporation, Ono PHARMA, Genexine; Non-Financial Interests, Personal, Research Funding: Daiichi Sankyo, Boehringer Ingelheim; Non-Financial Interests, Personal, Speaker’s Bureau: MSD, AstraZeneca, Roche, Takeda, Novartis, Daiichi Sankyo, Boehringer Ingelheim, Bristol Myers Squibb, Yuhan Corporation, Bayer. S. Kim: Financial Interests, Personal, Advisory Role, Advisory meeting participation: AstraZeneca; Financial Interests, Personal, Advisory Board, Advisory meeting participation: Amgen, Boehringer Ingelheim, Janssen, Novartis, Takeda, Therapex, Yuhan; Financial Interests, Personal, Other, Lecture: Boehringer Ingelheim; Financial Interests, Personal, Research Funding: Yuhan. D. Kahangire: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. S.P. Nagar, K.L. Davis, M. Jimenez: Financial Interests, Personal and Institutional, Speaker, Consultant, Advisor, RTI Solutions received consulting fees: AstraZeneca. M. Jung: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. M. Sandelin: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks or ownership: AstraZeneca. B.C. Cho: Financial Interests, Personal, Advisory Board: KANAPH Therapeutic Inc, Bridgebio therapeutics, Cyrus therapeutics, Guardant Health, Oscotec Inc; Financial Interests, Personal, Advisory Role, Consulting fees: Abion, BeiGene, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, BMS, CJ, CureLogen, Cyrus therapeutics, Ono, Onegene Biotechnology, Yuhan, Pfizer, Eli Lilly, GI-Cell, Guardant, HK Inno-N, Imnewrun Biosciences Inc., Janssen, Takeda, MSD, Janssen, Medp; Financial Interests, Personal, Member of Board of Directors: Interpark Bio Convergence Corp., J INTS BIO; Financial Interests, Personal, Other, Founder: DAAN Biotherapeutics; Financial Interests, Personal, Research Grant: MOGAM Institute, LG Chem, Oscotec, Interpark Bio Convergence Corp, GIInnovation, GI-Cell, Abion, AbbVie, AstraZeneca, Bayer, Blueprint Medicines, Boehringer Ingelheim, Champions Onoclogy, CJ bioscience, CJ Blossom Park, Cyrus, Dizal Pharma, Genexine, Jans; Financial Interests, Personal, Royalties: Champions Oncology, Crown Bioscience, Imagen; Financial Interests, Personal, Stocks/Shares: TheraCanVac Inc, Gencurix Inc, Bridgebio therapeutics, KANAPH Therapeutic Inc, Cyrus therapeutics, Interpark Bio Convergence Corp., J INTS BIO. All other authors have declared no conflicts of interest.