Authors: Riyaz Shah, Nicolas Girard, Saurabh P. Nagar, Frank Griesinger, Julia Roeper, Keith L. Davis, Parisa Karimi, William Sawyer, Ning Yu, Aliki Taylor & Josephine Feliciano
Abstract
Background
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the preferred first-line (1L) therapy for EGFR mutation-positive (EGFRm) advanced/metastatic non-small cell lung cancer (NSCLC).
Objective
Our objective was to describe real-world treatment patterns and T790M testing practices in patients with 1L disease progression (Europe/USA) following treatment with first- or second-generation EGFR-TKIs.
Methods
This was a retrospective, non-interventional medical record review of patients with EGFRm locally advanced/metastatic NSCLC from routine clinical practice (EGFR-TKI initiation: 1 January 2015 to 31 December 2017; follow-up: last available medical record). Endpoints were demographic/clinical characteristics, incidence of central nervous system (CNS) metastases/leptomeningeal disease, second-line (2L) treatment, T790M mutation testing, and osimertinib treatment prevalence.
Results
Among 469 patients, 73% (n = 341/469) progressed on 1L EGFR-TKI treatment. Of those who progressed, 74% (n = 252/341) were tested for T790M, with 50% (n = 126/252) testing positive; 75% (n = 94/126) of T790M-positive patients received osimertinib (mostly 2L). Of the patients with progression, 24% (n = 83/341) did not receive 2L treatment, and 88% (n = 73/83) of these patients died. At diagnosis of advanced disease, 9% of patients (n = 41) had CNS metastases; at EGFR-TKI initiation, 14% of patients (n = 68) had CNS metastases. Over the study period, 11% of patients (n = 42) developed CNS metastases not detected at NSCLC diagnosis.
Conclusions
Rates of resistance mutation testing and subsequent utilization of recommended 2L therapies could be improved. As more targeted therapies are developed, it will be crucial to improve the molecular testing rates to ensure patients receive appropriate, effective, and timely treatment.
Key Points |
In this retrospective, non-interventional medical record review of patients in Europe and the USA with epidermal growth factor receptor (EGFR) mutation-positive advanced non-small cell lung cancer (NSCLC), 73% progressed on first-line EGFR-tyrosine kinase inhibitor (TKI) therapy, and 24% of patients with disease progression did not receive second-line treatment. |
Rates of resistance mutation testing could be improved, as 26% of patients with disease progression were not tested for T790M and 25% of T790M-positive patients did not receive osimertinib at second or later line. |