Abstract 1395P
Background
Although osimertinib is a preferred first-line EGFR tyrosine kinase inhibitor (TKI) in patients with EGFR-mutant non-small cell lung cancer (NSCLC) based on longer progression free survival (PFS) and high CNS efficacy, other first- or second-generation EGFR TKIs (gefitinib, erlotinib or afatinib) still remain as treatment options. Since long-term responders (LTR) with first- or second-generation EGFR TKIs are often noted in proportion of patients in real world, it would be valuable to determine patient characteristics associated with long-term responders considering sequential approach of EGFR TKI in the management of EGFR-mutant NSCLC.
Methods
We analyzed EGFR-mutant advanced NSCLC patients treated with first-line gefitinib, erlotinib or afatinib from Jan 2013 to Dec 2016. LTRs were defined as patients whose PFS is longer than 36 months. We compared patient characteristics and other clinical outcomes between LTR group and control group.
Results
Of the 931 patients treated with first-line EGFR-TKI other than osimertinib, 140 (15.0%) patients were LTRs; gefitinib (n=85, 60.7%), erlotinib (n=22, 15.7 %), and afatinib (n=33, 23.6%), respectively. With median follow-up of 59.5 months, median PFS was 54.1 months and overall survival was not reached in the LTR group. Patients with recurrent disease (OR 0.40, p<0.001), Exon 19 deletion (OR 0.58, p=0.007) and without wet pleura (OR 3.11, p<0.001), bone (OR 1.93, p=0.003), CNS (OR 1.69, p=0.018) or other extrathoracic organ (OR 7.09, p=0.001) metastases were associated with LTRs.
Conclusions
In real world data, 15% of patients can achieve more than 3 years of treatment duration with first- or second-generation EGFR TKI alone. Given insufficient availability of osimertinib as first-line therapy in many countries and lack of established salvage therapy against osimertinib-resistant NSCLC, our results suggest that first- or second-generation EGFR TKIs can be considered for patients with recurrent disease, exon 19 deletion, and without wet pleura metastases as well as extrathoracic metastases.
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.