Abstract 158P
Background
Real-world evidence (RWE) regarding molecular epidemiology and management patterns of patients with epidermal growth factor receptor (EGFR) exon-20 mutated, advanced non-small-cell lung cancer (NSCLC) outside the context of clinical trials in Europe are lacking.
Methods
We created a European registry for patients with advanced EGFR exon 20-mutant NSCLC diagnosed from January 2019 to December 2021. Patients enrolled in clinical trials were excluded. Clinicopathological and molecular epidemiology data were collected and treatment patterns were recorded. Clinical endpoints according to treatment options were assessed using Kaplan-Meier curves and Cox-regression models.
Results
Data on 126 patients from 31 centers across 8 European countries were included. Median age was 65.4 years (range 29.7-87.8); Main features included female sex (61.6%), never smokers (60.3%), adenocarcinoma (93.7%) and tropism for bone (56.5%) and brain (32.2%) metastases. Mean PD-L1 TPS score was 20.5% (range 0-95) and mean TMB was 6.71 mut/MB (range 0-14). Exon 20 was detected in tissue (90.3%), in plasma (8.1%) or both (1.6%), using mostly targeted NGS (57.9%) or PCR (26.2%). Mutations were mainly insertions (59.1%) followed by duplications (29.1%), deletions-insertions (7.3%) and the T790M (4.5%). The majority of mutations (98.1%) were located in the adjacent loop (codons 767-775) and only 1.9% within the C-helix (codons 761-766). Main co-alterations were mutations in TP53 (61.3%) and MET amplifications (8.1%). Treatment included chemotherapy (CT) (27.8%), CT-IO (20%), osimertinib (16.5%), poziotinib (12.2%), mobocertinib (8.7%), mono-IO (5.2%) and amivantamab (1.7%). Disease control rates were 67.8% with CT+/- IO, 59.8% with osimertinib, 64.2% with poziotinib and 75% with mobocertinib. Corresponding median survival (OS) was 12.2, 7.9, 9.2 and 15.9 months respectively. Type of treatment (new targeted agents vs Chemo+/-IO) significantly affected OS (p=0.03).
Conclusions
EXOTIC represents the largest RWE dataset on EGFR exon 20 mutant NSCLC in Europe. Indirectly compared, treatment with new exon 20-targeting agents confers survival benefit over chemo+/-IO. Updated analysis will be presented in the meeting.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
G. Mountzios: Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Advisory Board: Takeda; Financial Interests, Personal, Invited Speaker: Amgen. P. Christopoulos: Financial Interests, Personal, Research Grant: Amgen; Financial Interests, Personal, Research Grant: AstraZeneca; Financial Interests, Personal, Research Grant: Boehringer Greece; Financial Interests, Personal, Research Grant: Novartis Hellas; Financial Interests, Personal, Research Grant: Roche; Financial Interests, Personal, Research Grant: Takeda; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Boehringer Ingelheim; Financial Interests, Personal, Advisory Board: Chungai; Financial Interests, Personal, Advisory Board: Daiichi Sankyo; Financial Interests, Personal, Advisory Board: Gilead; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: Takeda. N. Girard: Financial Interests, Personal, Advisory Board: Takeda; Financial Interests, Personal, Advisory Board: Janssen; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Invited Speaker: Janssen; Financial Interests, Personal, Invited Speaker: AstraZeneca Greece; Financial Interests, Personal, Research Grant: Takeda Hellas; Financial Interests, Personal, Research Grant: Janssen; Financial Interests, Personal, Research Grant: AstraZeneca. M.R. Garcia Campelo: Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Lilly; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: Lilly; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Takeda; Financial Interests, Personal, Advisory Board: MSD. K. Samitas: Financial Interests, Personal, Advisory Board: GSK; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Elpen; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: Medi-Globe; Financial Interests, Personal, Advisory Board: AstraZeneca Greece; Financial Interests, Personal, Advisory Board: Chiesi; Financial Interests, Personal, Advisory Board: Demo; Financial Interests, Personal, Advisory Board: Special Therapeutics; Financial Interests, Personal, Research Grant: GSK; Financial Interests, Personal, Research Grant: Novartis. G.L. Banna: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Astellas. I. Boukovinas: Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Invited Speaker: Janssen; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Invited Speaker: Novartis Greece; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Takeda; Financial Interests, Personal, Advisory Board: Janssen; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: Amgen; Financial Interests, Personal, Advisory Board: Novartis. A. Agbarya: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Advisory Board: Takeda Hellas; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb. A. Koumarianou: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: MSD. E.I. Perdikouri: Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: Janssen; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Merck Serono; Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Ipsen; Financial Interests, Personal, Invited Speaker: Servier; Financial Interests, Personal, Invited Speaker: Astellas; Financial Interests, Personal, Advisory Board: Leo; Financial Interests, Personal, Advisory Board: Angelini; Financial Interests, Personal, Advisory Board: Innovis; Financial Interests, Personal, Advisory Board: Sanofi; Financial Interests, Personal, Advisory Board: Astellas; Financial Interests, Personal, Advisory Board: Amgen. P. Kosmidis: Financial Interests, Personal, Other, Travel Grant: Pfizer; Financial Interests, Personal, Other, Travel Grant: MSD; Financial Interests, Personal, Other, Travel Grant: Sanofi; Financial Interests, Personal, Advisory Board: Bayer; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: LEO. M. Reck: Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Beigene; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Lilly; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Merck; Financial Interests, Personal, Invited Speaker: Mirati; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Advisory Board: Amgen; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Beigene; Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: Lilly; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Merck; Financial Interests, Personal, Advisory Board: Mirati; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: Sanofi; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Advisory Board: Takeda. G. Lo Russo: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: AstraZeneca. All other authors have declared no conflicts of interest.