Abstract 1125P
Background
Epidermal Growth Factor Receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) patients failing first-line (1L) EGFR- tyrosine kinase inhibitors (TKI) can benefit from subsequent targeted therapies. However, the real world data on the testing patterns and subsequent treatment patterns among patients failing 1L EGFR-TKI are lacking.
Methods
This is a multicenter, prospective observational study conducted in China. EGFR mutation-positive (EGFRm) advanced NSCLC patients failing 1L EGFR-TKI were included. The primary outcomes were treatment patterns and associated clinical outcomes. The secondary outcome was molecular testing patterns.
Results
From March 2020 to August 2021, 291 eligible patients were enrolled, including 273 (93.5%) patients failing 1L first- or second-generation (1G/2G) EGFR-TKI. T790M testing was performed in 205 (75.1%) patients on or after 1L 1G/2G EGFR-TKI progression. The T790M positive rate was 47.8% (98/205), with 54.7% (35/64) in tissue biopsies and 44.7% (63/141) in liquid biopsies. 91 (92.9%) T790M positive patients received 2L treatment. Among them, 89 (97.8%) patients received 2L 3G EGFR-TKI based treatment, accounting for only 32.6% of all 1L 1G/2G EGFR-TKI failed patients. Table: 1125P
Real world testing and treatment pattern of EGFRm NSCLC patients failing 1L 1G/2G EGFR-TKI (N=273)
| Number of patients (%) | |
| Patients received T790M mutation testing on or after 1L progression | 205 (75.1%) |
| Patients with T790M positive | 98 (35.9%) |
| T790M positive patients received 2L treatment | 91 (33.3%) |
| T790M positive patients received 2L 3G EGFR-TKI based treatment | 89 (32.6%) |
Conclusions
The data showed that although EGFR T790M mutation guided subsequent treatment of EGFRm NSCLC patients following 1L 1G/2G EGFR-TKI progression, 24.9% of these patients did not receive T790M testing in real world setting. Eventually, only a third of patients received 2L 3G EGFR-TKI based treatment upon progression on 1L 1G/2G EGFR-TKIs. These results suggested that 3G EGFR-TKI should be used in the 1L setting to ensure that all patients could receive the best EGFR-TKI to achieve better survival.
Clinical trial identification
NCT04207775.
Editorial acknowledgement
Legal entity responsible for the study
AstraZeneca.
Funding
AstraZeneca.
Disclosure
All authors have declared no conflicts of interest.