Abstract 1225P
Background
As a third generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), osimertinib is recommended as standardized treatment for advanced or metastatic non-small cell lung cancer (NSCLC) patients with EGFR-T790M mutation after progressed on first-line EGFR-TKI. Our study aims to investigate the prognostic value of first-line EGFR-TKI on the second-line osimertinib in the real-world practice.
Methods
A total of 198 NSCLC patients with EGFR-T790M between 2016 and 2020 were included in this study. All patients were resistant to first-line EGFR-TKI and received osimertinib as second-line therapy. The endpoint was the occurrence of progression on osimertinib. Univariate and multivariate COX regression analysis were used to identify the prognostic value of clinical factors. Log-rank test was conducted to compare survival outcomes of different groups.
Results
At the end of follow-up, disease progression occurred in 132 (66.7%) patients. The median PFS of the second-line osimertinib was 12.2-Mo (95%CI: 10.8-14.7 Mo). In the first-line EGFR-TKI treatment, the median PFS of the total cohort was 13.0 Mo. A longer PFS of the first-line EGFR-TKI was associated with a delayed disease progress of the second-line osimertinib (HR, 95%: 0.969, 0.948-0.990, P =0.004) in univariate analysis. Other factors that could predict the survival outcomes of the second-line osimertinib therapy included pretreatment T stage, M stage and performance status. In the multivariate analysis, the PFS of the first-line EGFR-TKI was still a predictor of the second-line osimertinib (HR, 95%: 0.970, 0.948-0.993, P =0.011). Patients with PFS of the first-line EGFR-TKI over 13.0 Mo had much favorable prognosis in the second-line osimertinib than those with PFS of the first-line EGFR-TKI less than 13.0 Mo (median PFS: 17.0 Mo vs. 10.2 Mo, P =0.009).
Conclusions
Our study identified that the PFS of the first-line EGFR-TKI was a strong prognosticator of the second-line osimertinib for NSCLC patients with EGFR-T790M. This finding would be helpful for clinical decision-making and patients’ consultation.
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.