Abstract 1244P
Background
After an initial response to first- or second-generation (1G/2G) epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) roughly one-half of patients (pts) with advanced EGFR mutated (EGFRm) non-small cell lung cancer (NSCLC) develop resistance due to a secondary T790M mutation. REFLECT study (NCT04031898) explored EGFR/T790M testing and treatment patterns in EGFRm NSCLC pts receiving 1G/2G EGFR TKis in 8 countries. Pooled data from Central Eastern Europe (CEE) are presented here.
Methods
This physician-led chart review was conducted in 25 hospitals and data were retrieved from 389 medical records. 4 CEE countries participated: Bulgaria, Poland, Romania and Slovenia. Eligible pts received first-line (1L) 1G/2G EGFR TKIs during Jan 2016-Jun 2018. Sampling methods for EGFR /T790M mutation testing and treatment strategies after 1L progression were recorded. Descriptive statistics and Kaplan-Meier methods for median progression free survival (mPFS) were used.
Results
EGFR testing is reflex in 52% of sites; T790M testing at progression is reflex in 36% of sites and on-demand in the rest. In this group (median age 68 yrs, 69% female) EGFR testing results were available after a median time of 0.5 months (mo) since advanced NSCLC diagnosis. Tissue biopsy was used in 83% cases. Identified mutations: exon 19 deletion 52%, L858R 34%, uncommon variants 14%. 1L TKIs used: 37% erlotinib, 34% afatinib, 30% gefitinib. Out of 298 (77%) pts progressing on 1L TKIs, 200 (67%) were tested for T790M with positive result in 115 (58%) cases. T790M was tested from liquid biopsy (75%), tissue biopsy (17%) and cytology specimen (8%). mPFS on 1L TKIs was 14.0 (95% CI 12.6, 15.6) mo, with a median time from 1L start to T790M testing of 12.8 mo. In pts with T790M mutation, 111 (97%) received osimertinib in subsequent lines, mostly in 2L (93%).
Conclusions
REFLECT study provided a detailed insight of EGFR and T790M testing patterns in 4 CEE countries. The results showed that one-third of pts were not tested for T790M in an era of 2L treatment driven by this assessment. Local specific measures are needed to improve T790M testing rate in the future in pts not using osimertinib in 1L.
Clinical trial identification
NCT04031898.
Editorial acknowledgement
Editorial support was provided by Ana Maria Iordan (MedInteractiv) and was funded by AstraZeneca.
Legal entity responsible for the study
AstraZeneca.
Funding
AstraZeneca.
Disclosure
M. Dediu: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Advisory Role: AstraZeneca; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Advisory Role: Pfizer; Financial Interests, Personal, Invited Speaker: Astellas; Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Invited Speaker: Accord Health Care; Financial Interests, Personal, Invited Speaker: Novartis Pharma; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Sandoz; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Advisory Role: Amgen; Financial Interests, Personal, Advisory Role: Accord Health Care; Financial Interests, Personal, Advisory Role: Bristol Myers Squibb; Financial Interests, Personal, Advisory Role: Roche; Financial Interests, Personal, Advisory Role: Novartis; Financial Interests, Personal, Advisory Role: MSD; Financial Interests, Personal, Advisory Role: Takeda; Financial Interests, Personal, Advisory Role: Ipsen. U. Janzic: Financial Interests, Personal, Other: AstraZeneca; Financial Interests, Personal, Other: Boehringer Ingelheim; Financial Interests, Personal, Other: MSD; Financial Interests, Personal, Other: Roche; Financial Interests, Personal, Other: Pfizer; Financial Interests, Institutional, Other: AstraZeneca; Financial Interests, Institutional, Other: Boehringer Ingelheim; Financial Interests, Institutional, Other: MSD; Financial Interests, Institutional, Other: Roche; Financial Interests, Institutional, Other: Pfizer; Financial Interests, Institutional, Other: Novartis; Financial Interests, Institutional, Other: Bristol Myers Squibb. M.V. Marinca: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: Merck; Financial Interests, Personal, Invited Speaker: Johnson & Johnson; Financial Interests, Personal, Invited Speaker: Eli Lilly; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Accord Health Care; Financial Interests, Personal, Invited Speaker: Novartis Pharma; Financial Interests, Personal, Invited Speaker: Amgen Romania; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Sandoz; Financial Interests, Personal, Invited Speaker: Astellas; Financial Interests, Personal, Invited Speaker: Angelini Pharmaceuticals; Financial Interests, Personal, Invited Speaker: Ipsen; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Egis; Financial Interests, Personal, Invited Speaker: Solacium; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: Ipsen; Financial Interests, Personal, Advisory Board: Egis; Financial Interests, Personal, Advisory Board: Sandoz; Financial Interests, Personal, Other: Merck; Financial Interests, Personal, Other: Bristol Myers Squibb; Financial Interests, Personal, Other: Roche; Financial Interests, Personal, Other: Pfizer; Financial Interests, Personal, Other: Astellas. A. Pluzanski: Financial Interests, Personal, Speaker’s Bureau: AstraZeneca; Financial Interests, Personal, Speaker’s Bureau: Boehringer Ingelheim; Financial Interests, Personal, Speaker’s Bureau: Pfizer; Financial Interests, Personal, Expert Testimony: Bristol Myers Squibb; Financial Interests, Personal, Other: AstraZeneca; Financial Interests, Personal, Expert Testimony: Boehringer Ingelheim; Financial Interests, Personal, Other: Pfizer; Financial Interests, Personal, Other: MSD; Financial Interests, Personal, Other: Roche; Financial Interests, Personal, Expert Testimony: AstraZeneca; Financial Interests, Personal, Other: Boehringer Ingelheim; Financial Interests, Personal, Other: Bristol Myers Squibb; Financial Interests, Personal, Advisory Role: MSD. N. Turnsek: Financial Interests, Personal, Other: AstraZeneca; Financial Interests, Personal, Other: Boehringer Ingelheim; Financial Interests, Personal, Other: MSD; Financial Interests, Personal, Other: Roche; Financial Interests, Personal, Other: Pfizer; Financial Interests, Institutional, Other: MSD; Financial Interests, Institutional, Other: Boehringer Ingelheim; Financial Interests, Institutional, Other: Roche; Financial Interests, Institutional, Other: Pfizer; Financial Interests, Institutional, Other: AstraZeneca. R. Lupu: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. G. Teodorescu: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. All other authors have declared no conflicts of interest.