Abstract 1152P
Background
Among patient (pts) who have advanced NSCLC with EGFR driver mutations (EGFRm), most benefit from EGFR tyrosine kinase inhibitors (TKIs). The ADAURA trial showed significant improvement in disease-free survival (DFS) with the addition of the EGFR TKI, osimertinib, in resected early stage (IB-IIIA) EGFRm NSCLC pts. The objective of the POTENT study was to estimate EGFRm prevalence and assess outcomes in resected early stage EGFRm NSCLC in real-world setting in Canada.
Methods
Retrospective chart review was conducted for all adult pts with resected stage IB-IIIA NSCLC diagnosed between Jan 2016 and Dec 2019 at 3 Canadian Cancer Centers. Data on EGFRm status, treatments and clinical outcomes were collected.
Results
Of 440 stage IB-IIIA pts whose tumors had EGFR reflex testing, 95 (22%) were EGFRm. Among pts with EGFRm tumors, mean age was 65 years; 66% were female; among those with known ethnicity, 23% were Asian. Of total, 12.5% with stage IB, 75.0% with stage II, and 82.4% with stage IIIA received adjuvant therapy. Median follow-up time was 29 months. Disease-free survival (DFS) at 2 years was 84.6%, 53.9% and 35.9% for stages IB, II and IIIA, respectively. Number of DFS events at 2 years, median DFS in months, and probability of being alive at 2 years are presented in the table. At time of first recurrence, 85.7% involved distant sites; among distant first recurrences, CNS metastasis occurred in 33% of stage IB, 9% of stage II, and 10% of stage IIIA pts. Table: 1152P
| Variable | Number of patients (number of DFS events at 2 years) | Median DFS in months (95%, CI) | Probability of being alive at 2 years (95% CI) |
| Stage | |||
| IB | 48 (10) | NR (38.2-NE) | 0.95 (0.88-1.00) |
| II | 28 (14) | 31.5 (17.0-NE) | 0.92 (0.83-1.00) |
| IIIA | 17 (12) | 18.7 (14.1-NE) | 0.87 (0.72-1.00) |
| II and IIIA combined | 45 (26) | 22.6 (16.6-38.9) | 0.90 (0.82-1.00) |
| Mutation type | |||
| Common mutation | 57 (22) | 38.2 (32.5-NE) | 0.94 (0.88-1.00) |
| Uncommon mutation | 36 (14) | 38.9 (21.0-NE) | 0.88 (0.78-1.00) |
| Surgical resection status | |||
| R0 | 91 (35) | 38.2 (31.5-NE) | 0.92 (0.87-0.98) |
| R1 | 1 (1) | 17 (NE-NE) | NA |
| R2 | 1 (0) | NR (NE-NE) | NA |
| Adjuvant chemotherapy | |||
| Did not receive | 51 (14) | 40.7 (38.2-NE) | 0.90 (0.82-1.00) |
| Received | 42 (22) | 31.5 (18.7-NE) | 0.95 (0.93-1.00) |
Conclusions
Real-world data provide critical context to clinical trials and inform treatment and reimbursement decisions. Pts with resected IB-IIIA EGFRm NSCLC had suboptimal outcomes, despite adjuvant chemotherapy. These results highlight the need for improved therapeutics for this patient population.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Paleos Steering Committee.
Funding
Pulse Infoframe Inc. and AstraZeneca.
Disclosure
M.S. Kuruvilla: Financial Interests, Advisory Board: AstraZeneca; Financial Interests, Advisory Board: Bristol Myers Squibb; Financial Interests, Advisory Board: Novartis. I. Syed: Financial Interests, Personal and Institutional, Full or part-time Employment: AstraZeneca. B. Sheffield: Financial Interests, Advisory Board: Amgen; Financial Interests, Advisory Board: AstraZeneca; Financial Interests, Advisory Board: Bayer; Financial Interests, Advisory Board: Biocartis; Financial Interests, Advisory Board: Boehringer Ingelheim; Financial Interests, Advisory Board: Eli Lilly; Financial Interests, Advisory Board: EMD Serono; Financial Interests, Advisory Board: Janssen; Financial Interests, Advisory Board: Merck; Financial Interests, Advisory Board: Novartis; Financial Interests, Advisory Board: Pfizer; Financial Interests, Advisory Board: Roche; Financial Interests, Advisory Board: Thermo Fisher. D. Moldaver: Financial Interests, Full or part-time Employment: AstraZeneca. M. Shanahan: Financial Interests, Full or part-time Employment: AstraZeneca. P. Cheema: Financial Interests, Advisory Board: AstraZeneca; Financial Interests, Advisory Board: Amgen; Financial Interests, Advisory Board: Roche; Financial Interests, Advisory Board: Bristol Myers Squibb; Financial Interests, Advisory Board: Novartis; Financial Interests, Advisory Board: Takeda; Financial Interests, Advisory Board: Pfizer; Financial Interests, Advisory Board: EMD Serono. All other authors have declared no conflicts of interest.