Abstract 675P
Background
Metastatic non-small cell lung cancer (mNSCLC) has historically poor survival. Next-generation sequencing (NGS) has improved identification of oncogene driver mutations, present in 70%. While 1st line targeted therapies have improved outcomes, managing resistance remains a challenge. This study investigates 2nd line therapies in patients with Epidermal Growth Factor Receptor (EGFR) mutant mNSCLC.
Methods
The EnRICH study prospectively collected data on lung cancer patients across Australia. Patients with EGFR-driven mNSCLC were analysed. Endpoints included Progression-Free Survival 1 (PFS1) and 2 (PFS2), measured from first- and second-line treatments to disease progression respectively.
Results
Of the 2000 patients diagnosed with lung cancer between September 2016 - October 2021, 647 patients with NSCLC underwent molecular testing, revealing 21% with an EGFR mutation. 69 patients with EGFR mutations, who received first-line Tyrosine-Kinase Inhibitor (TKI) therapy and required subsequent therapy due to progressive disease underwent further analysis. In the first-line setting, 67% were treated with a first-generation TKI (Erlotinib: n=40, Gefitnib: n=7). Second-line, 49% received systemic therapy alone and 17% in combination with radiotherapy. A significant proportion (49%) were treated with second-line TKI, with the majority (93%) receiving the third-generation TKI Osimertinib. Overall median PFS1 was 8 months and PFS2 was 8 months. PFS2 was statistically superior in the TKI cohort compared with the chemotherapy/immunotherapy cohort (12 vs 5 months, P=0.005).
Conclusions
This study uses real-world data from the EnRICH database, representing the largest retrospective analysis of this cohort in Australia. It highlights the trend toward utilising second-line Osimertinib and suggests its potential superiority compared to other therapies. These results offer valuable insights into real-world management strategies and emphasises the need to refine them, particularly with the growing availability of NGS and next-generation TKIs, to enhance patient outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.