Abstract 205P
Background
EGFR-TKIs combined with chemotherapy have shown significant efficacy in treating advanced NSCLC with EGFR mutations. The FLAURA2 study demonstrated that EGFR-TKI combined with chemotherapy improves the objective response rate compared to EGFR-TKI alone. However, the efficacy of EGFR-TKI plus chemotherapy versus EGFR-TKI monotherapy for locally advanced EGFR-mutant NSCLC patients remain unclear. This study aims to compare the real-world efficacy of EGFR-TKI combined with chemotherapy versus EGFR-TKI alone in locally advanced stage IIIA-N2 to IIIC EGFR-mutant NSCLC, focusing on oncological outcomes and potential survival benefits.
Methods
From January 2017 to December 2022, patients diagnosed with biopsy-confirmed stage IIIA-N2 to IIIC NSCLC and harboring EGFR mutations (L858R or exon 19 deletion), who received either EGFR-TKI combined with chemotherapy or EGFR-TKI monotherapy, were identified. Patients received EGFR-TKIs and chemotherapy for at least two 28-day cycles. Surgical and oncologic outcomes of the included patients were collected.
Results
A total of 34 patients were enrolled, including 13 stage IIIA-N2, 19 stage IIIB, and 2 stage IIIC cases. The combination therapy group showed a higher ORR compared to the EGFR-TKI monotherapy group [72.7% (8/11) vs. 47.8% (11/23)]. The most common procedure performed was lobectomy (31 cases, 91.2%), all achieving R0 resection with negative margins. In the combination group, the proportion of major pathological response (MPR) was 36.4% (4/11), compared to 26.1% (6/23) in the EGFR-TKI monotherapy group. No complete pathological response (pCR) was observed in either group. Lymph node downstaging confirmed by pathology was observed in 72.7% (8/11) of combination therapy patients versus 43.4% (10/23) in the monotherapy group. At a median follow-up of 34.7 months, median disease-free survival (DFS) in the combination group was not reached, while the monotherapy group had a DFS of 25.2 months (95% CI: 0.0–62.1). Overall survival (OS) data were immature.
Conclusions
EGFR-TKI combined with chemotherapy may enhance tumor downstaging and increase the MPR rate in locally advanced EGFR-mutant NSCLC.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.