1341P - Real-world molecular testing, treatment patterns and clinical outcomes in Chinese advanced NSCLC patients, who have progressed on first-line EGFR-TKI therapy (PISCES)

Background

The aim of PISCES study is to assess the molecular testing, treatment patterns and clinical outcomes among Chinese patients progressed on first-line (1L) EGFR-TKI monotherapy in real-world setting.

Methods

This prospective study enrolled EGFR mutant, locally advanced or metastatic NSCLC patients progressed on 1L EGFR-TKI monotherapy from May 2020 to May 2021 in 16 Chinese hospitals. The treatment patterns and clinical outcomes were recorded.

Results

292 patients received 1L EGFR-TKI monotherapy were enrolled. 93.8% (274/292) of patients received first/second generation (1/2G) EGFR-TKI and 6.2% (18/292) received third generation (3G) EGFR-TKI. 74.8% (205/274) of patients who progressed on 1L 1/2G EGFR-TKI underwent genetic testing, and 47.8% (98/205) of them were T790M positive (T790M+). 91.8% (90/98) of T790M+ patients received 3G EGFR-TKI as 2L therapy. Among the 107 patients with T790M negative (T790M-), 47.8% (51/107) received 3G EGFR-TKI, 25.2% (27/107) received chemotherapy and 8.4% (9/107) received prior 1/2G EGFR-TKI plus local therapy as 2L therapy. Among 18 patients progressed on 1L 3G EGFR-TKI, half (9/18) of them received chemotherapy, 27.8% (5/18) switched to another 3G EGFR-TKI. The overall median PFS (mPFS) of patients who had received 2L treatment was 9.1 months (95%CI, 7.6-11.2). The mPFS of patients receiving 2L 3G EGFR-TKI, prior 1/2G EGFR-TKI plus local therapy, and chemotherapy was 10.5 months (95%CI, 8.7-13.7), 10.2 months (95%CI, 5.3-19.2) and 5.5 months (95%CI, 3.3-8.6), respectively. Among those receiving 2L 3G EGFR-TKI treatment, T790M+ patients achieved significantly longer mPFS compared to T790M- patients (13.7 vs 7.6 months, P=0.012). For patients with T790M-, the mPFS was comparable (7.6 vs 5.5 months, P=0.07) when received 3G EGFR-TKI and chemotherapy as 2L therapy.

Conclusions

Most patients progressed on 1L EGFR-TKI monotherapy underwent genetic testing in Chinese real-world setting. The vast majority of T790M+ patients received 3G EGFR-TKIs treatment. Although almost half of T790M- patients received 3G EGFR-TKI as 2L therapy, these patients achieved suboptimal clinical outcome.

Clinical trial identification

NCT04207775.

Editorial acknowledgement

Legal entity responsible for the study

AstraZeneca.

Funding

AstraZeneca.

Disclosure

All authors have declared no conflicts of interest.