Abstract 71P
Background
The treatment of aNSCLC has advanced over decades with insights into oncogenic mutations like EGFR, present in 10–20% of NSCLC cases. Third-generation EGFR tyrosine kinase inhibitors (TKIs) are now the standard first-line (1L) treatment for common EGFRm (cEGFRm) aNSCLC. However, long-term real-world (RW) studies on the evolution of EGFRm care are lacking, leaving uncertainties about whether advancements have improved patient outcomes. This study examines changes in clinical characteristics, treatment pathways, and outcomes of aNSCLC patients with exon 19 deletions and L858R substitutions (known as cEGFRm) from 2010 to 2023.
Methods
This retrospective observational study utilized national registry data and hospital data lakes for cEGFR-mutated aNSCLC patients treated in two Finnish university hospitals from 2010 to 2023, covering 55% of NSCLC cases in Finland. Patient characteristics, 1L treatment patterns, and outcomes (time to next treatment [TTNT] and overall survival [OS]) were analyzed over three periods based on the availability of first-generation TKIs (2010–2016), second-generation TKIs (2017–2020), and third-generation TKIs (2020–2023). Outcomes, including hazard ratios, were assessed using Kaplan-Meier and Cox regression analyses.
Results
The study included 379 patients (mean age 69.5 years; 69% women; 85% Stage IV, 54% exon 19 deletion). Of these, 18% (n=68) received chemotherapy (CT) as a 1L treatment, while 82% (n=311) received TKIs. First-line treatment increased from 68% (88 out of 129 patients) receiving TKIs in 2010–2016 to 94% (116 out of 123 patients) in 2020–2023, with 80% in 2023 receiving third-generation TKIs. Median OS improved from 19 months (2010–2016) to 24 months (2017–2020) and 29 months (2020–2023), while median TTNT increased from 10 to 13 and 21 months over the same periods.
Conclusions
This study in Finland showed that median OS and TTNT have improved over time, and these outcomes were positively impacted by the evolution from 1st to 2nd and 3rd gen TKI, but outcomes remain poor, highlighting the need for treatment innovation and new therapies.
Legal entity responsible for the study
M. Silvoniemi.
Funding
Johnson & Johnson.
Disclosure
L. Nurmi: Financial Interests, Institutional, Full or part-time Employment, consulting fees paid to Johnson & Johnson: Nordic Healthcare Group Oy. P. Vänni: Financial Interests, Institutional, Full or part-time Employment, consulting fees paid to Johnson & Johnson: Nordic Healthcare Group Oy. J. Edwards, M. Ekblom, I. Luccarini: Financial Interests, Institutional, Full or part-time Employment: Johnson & Johnson. All other authors have declared no conflicts of interest.