2941 - Treatment patterns of EGFR mt+ NSCLC IV pts: Real world data of the NOWEL network

Background

The percentage of pts switching from 1^st gen TKI in 1^st line to 3^rd gen TKI in 2^nd line seems to be low with 30% and it is questionable whether these data represent real world treatments. Therefore, we investigated the treatment pattern and especially the attrition rate between 1^st and 2^nd line therapy in EGFR mt+ pts from the NOWEL network.

Methods

A retrospective study of 1539 pts with non-squamous NSCLC IV was accomplished. 965/1536 (63%) pts were tested for EGFR mt+ between 2009-2018. 148/965 (15%) pts with an EGFR mt+ were identified. To calculate PFS and OS we used Kaplan Meier methods and the log rang test for p-values.

Results

Baseline characteristics of 148 EGFR mt+ pts: median age 65 yrs; 64% female (n = 95/148); 64% never/light smoker (n = 94/148). 135/148 pts (91%) carried an EGFR mt+ either del19 (n = 81) or L858R (n = 55). 144/148 pts were treated with TKI on 1^st or 2^nd line (after chemotherapy) and 4 pts received no therapy at all. 14/144 pts are still on 1^st line, 9 pts were lost to follow-up and 3 pts died while on 1^st line therapy. We identified 118/144 candidates for 2^nd line therapy (because of progression on 1^st line TKI) and only 84/118 (70%) pts received a 2^nd line therapy. 30% (36/118) of pts did not receive a 2^nd line therapy because of bad PS (n = 26), pts refusal (n = 2), fast progression (n = 6) and death (n = 2). After accessibility of 3^rd gen TKI 72 pts were candidates for 2^nd line treatment and 51/71 pts (71%) received a 2^nd line therapy. MOS of pts receiving 2^nd line therapy after access to 3^rd gen TKI was 35 mo for pts with 2^nd line therapy vs. 10 mo without 2^nd line (p < 0.000). 32/51 pts (63%) were tested for T790M and 20/32 (62%) were T790M+. Highest T790M testrate in one center was 22/28 (79%). 16/20 (80%) T790M+ pts received 3^rd gen TKI for 2^nd line therapy. MOS of pts receiving 3^rd gen TKI (n = 31) was 51 mo vs. 25 mo for pts without 3^rd gen TKI (p < 0.002).

Conclusions

In real world, a significant number of pts treated with 1^st or 2^nd gen TKI do not reach 2^nd line therapy even with broad accessibility of 3^rd gen TKI. Reasons for not receiving 2^nd line therapy are in most cases deterioration of PS, death and no testing for T790M in a minority of cases. These data are important for the interpretation of the OS data of the FLAURA study as they reflect real world treatment algorithms in dedicated German lung cancer centers.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Carl v. Ossietzky University of Oldenburg, Prof. Dr. Griesinger.

Funding

Has not received any funding.

Disclosure

J. Roeper: Honoraria (self): Boehringer Ingelheim; Honoraria (self): Roche; Honoraria (self): AstraZeneca. M. Falk: Advisory / Consultancy: Pfizer; Honoraria (self), Advisory / Consultancy: Boehriger Ingelheim; Honoraria (self): Roche; Honoraria (self): AstraZeneca. M. Tiemann: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Novartis; Honoraria (self), Advisory / Consultancy: Boehriger Ingelheim; Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self), Advisory / Consultancy: Roche ; Honoraria (self): AstraZeneca. F. Griesinger: Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): AstraZeneca; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Boehriger Ingelheim; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Novartis; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Pfizer; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Roche; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): BMS; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): MSD; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Celegene; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Lilly; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Takeda; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Research grant / Funding (institution): Siemens; Honoraria (self), Advisory / Consultancy: AbbVie; Honoraria (self), Advisory / Consultancy: Bayer. All other authors have declared no conflicts of interest.