91P - Treatment (tx) patterns and outcomes in resectable early-stage non-small cell lung cancer (NSCLC): A global real-world (rw) study

Background

Complete resection ± adjuvant chemotherapy is recommended for most patients (pts) with early-stage (I–IIIA) NSCLC; however, 5-year overall survival (OS) rates for this regimen decrease with advancing disease stage. Osimertinib is a third-generation, EGFR-tyrosine kinase inhibitor approved as adjuvant tx for resected stage IB–IIIA EGFR mutated (EGFRm) NSCLC, based on the ADAURA trial results. We report final results from a global retrospective chart review of electronic health records (EHRs) for pts with resected stage IA–IIIA NSCLC, to show EGFRm frequency, tx patterns and outcomes prior to osimertinib approval.

Methods

Adults (≥18 yrs) with completely resected stage IA–IIIA NSCLC with available EGFRm results, who were diagnosed between 01Jan2014–31Dec2017, were assessed from diagnosis (Dx) until last follow-up/death. Primary endpoints included EGFRm frequency, tx patterns and OS. Sites of 1^st recurrence was a secondary endpoint.

Results

EHRs were collected from 1243 pts in 8 countries. Of 530 pts (43%) with EGFRm NSCLC (pt characteristics, table); 251 (47%) received surgery only (88% were stage I), 32 (6%) received surgery + neoadjuvant tx, and 177 (33%) received surgery + adjuvant tx. Chemotherapy was the most common adjuvant tx (170/177, 95% [n = 14 stage IA, 37 stage 1B, 56 stage II, 63 stage III]). After a median follow-up of 58 months (IQR 46–73) median OS was not reached; 5-year OS probability was 78%. Five-year OS probabilities for stages IA/IB/IIA/IIB/IIIA were 94%/85%/73%/76%/46%. For 113 pts who received (neo)adjuvant tx, the most common sites of 1^st recurrence were lung (38%) and brain (28%).

Conclusions

In this rw international study of pts with completely resected stage IA–IIIA EGFRm NSCLC, diagnosed between 2014 and 2017, 5-year landmark OS probabilities decreased from 94% to 46% from stage IA to IIIA. Early Dx and EGFR testing to inform optimal tx may improve outcomes in this population.

Editorial acknowledgement

The authors would like to acknowledge Laura Crocker, BMedSci (hons), of Ashfield MedComms, an Inizio Company, for medical writing support that was funded by AstraZeneca in accordance with Good Publications Practice (GPP) guidelines.

Legal entity responsible for the study

AstraZeneca.

Funding

AstraZeneca.

Disclosure

S. Lin: Financial Interests, Personal, Full or part-time Employment: MD Anderson Cancer Center; Financial Interests, Personal, Stocks/Shares: Meta, Apple, Google, Amazon, Tesla, Rivian; Financial Interests, Personal, Advisory Role: AstraZeneca, Creatv Microtech; Financial Interests, Personal, Other, Consulting fees: XRAD Therapeutics; Financial Interests, Personal, Research Grant: STCube Pharmaceuticals, Nektar therapeutics, Beyond Spring Pharmaceuticals.

D. Kahangire: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks/Shares: AstraZeneca.

S. Nagar: Financial Interests, Institutional, Funding: AstraZeneca.

M. Ahn: Financial Interests, Personal, Other, Consulting fee: Alpha Pharmaceutical, AstraZeneca, Ono Pharmaceutical Co., Ltd., Roche; Financial Interests, Personal, Other, Consulting fees: Bristol-Myers Squibb, Merck Sharp & Dohme, Takeda; Financial Interests, Personal, Other: AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Ono Pharmaceutical Co., Ltd., Roche.

J. Agulnik: Financial Interests, Personal, Other, Consulting fee: AbbVie, Amgen, Bayer, Bristol-Myers Squibb, EMD-Sereno, Exactis, Eli Lilly, Merck, Novartis, Pfizer, Purdue, Roche, Takeda; Financial Interests, Personal, Other, Consulting fees: AstraZeneca.

J. Shih: Financial Interests, Personal, Other, Honoraria: ACTgenomics, Amgen, Genconn Biotech, AstraZeneca, Roche, Bayer, Boehringer Ingelheim, Eli Lilly, Pfizer, Novartis, Merck Sharp & Dohme, Chugai Pharmaceutical, Co., Ltd., Takeda, CStone Pharmaceuticals, Janssen, TTY Biopharm, Orient EuroPharma, MundiPharma, Ono Pharmaceutical Co., Ltd., Bristol-Myers Squibb; Financial Interests, Institutional, Funding: Roche.

M.J. Hochmair: Financial Interests, Personal, Advisory Role: Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Merck Sharp & Dohme, Roche, Takeda; Financial Interests, Personal, Other, Speaker fee: Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Merck Sharp & Dohme, Roche, Takeda.

A. Tufman: Financial Interests, Personal, Full or part-time Employment: LMU University Hospital of Munich; Financial Interests, Personal, Other, Honoraria: Eli Lilly, Pfizer, Novartis, AstraZeneca, Amgen, Celgene, Takeda, Janssen, Roche, Merck Sharp & Dohme, Bristol-Myers Squibb, Boehringer Ingelheim.

J. Chow: Financial Interests, Personal, Other, Honoraria: AstraZeneca, Roche, Bristol-Myers Squibb; Financial Interests, Personal, Other, Conference fees: Takeda.

M. Jimenez: Financial Interests, Institutional, Funding: AstraZeneca.

K. Davis: Financial Interests, Institutional, Funding: AstraZeneca.

M. Sandelin: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks/Shares: AstraZeneca.

R. Veluswamy: Financial Interests, Personal, Full or part-time Employment: Icahn School of Medicine at Mount Siani; Financial Interests, Personal, Advisory Role: Bristol-Myers Squibb, AstraZeneca, Merck, Boehringer Ingelheim, Merus, Novocure, Regeneron; Financial Interests, Personal, Funding: Bristol-Myers Squibb, Onconova, AstraZeneca, Boehringer Ingelheim.

All other authors have declared no conflicts of interest.