Abstract
BackgroundThe objective of this study was to investigate real-world EGFR mutation testing in patients with metastatic non-small cell lung cancer (NSCLC) upon progression on first−/second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI), and subsequent treatments received.MethodsFlatiron Health electronic health records-derived database was used to identify adult patients with metastatic NSCLC treated with first−/second-generation EGFR-TKI from 11/2015–09/2017, with start of first EGFR-TKI defined as the index date. Patients were stratified by receipt of EGFR-TKI as first-line (1 L) or later-line (2 L+) treatment. Mutation testing and subsequent therapies following first−/second-generation EGFR-TKI were described.ResultsOverall, 782 patients (1 L = 435; 2 L+ =347) were included. Median age was 69.0 years, 63.6% were female, 56.3% were white, 87.1% were treated in community-based practices, and 30.1% of patients died during the study period; median follow-up was 309.0 days. Among the 294 (1 L = 160; 2L+ =134) patients who received subsequent therapies, treatments included chemotherapy only (1 L = 15.6%; 2L+ =21.6%), immunotherapy only (1 L = 13.8%; 2 L+ =41.0%), and targeted therapies (1 L = 70.0%; 2 L+ =36.6%). Specifically, 40 (25.0%) 1 L patients and 7 (5.2%) 2 L+ patients received osimertinib as subsequent therapy. Before the start of subsequent therapy, EGFR T790M resistance mutation testing was performed in 88 (29.9%) patients (1 L = 63 [39.4%]; 2 L+ =25 [18.7%]). Of these patients, 25 (28.4%) were T790M positive, among whom 24 (96.0%) received osimertinib.ConclusionsA third of patients received subsequent therapies on disease progression; only 30% of these were tested for EGFR-TKI resistance mutation, prior to receiving subsequent therapies. These results highlight the importance of choosing treatments in the 1 L setting that optimize benefits for patients with EGFR-mutated NSCLC.
Highlights
The objective of this study was to investigate real-world EGFR mutation testing in patients with metastatic non-small cell lung cancer (NSCLC) upon progression on first−/second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI), and subsequent treatments received
Clinical guidelines recommend T790M testing for patients with resistance to first- or second-generation EGFR-TKIs, yet uptake of such testing in real-world practice is unknown [17]. In this real-world study, we aimed to describe the utilization of EGFR mutation testing of patients on progression with first- or second-generation EGFR-TKIs, subsequent treatments received, and the proportion of T790M positive patients treated with osimertinib
435 patients received an EGFR-TKI as initial systemic therapy (1 L) and 347 as subsequent therapy (2 L+)
Summary
The objective of this study was to investigate real-world EGFR mutation testing in patients with metastatic non-small cell lung cancer (NSCLC) upon progression on first−/second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI), and subsequent treatments received. Systemic therapy for metastatic non-small cell lung cancer (NSCLC) varies according to tumor histology and mutation status of patients. Epidermal growth factor receptor (EGFR) mutation-positive tumors are highly responsive to EGFRtyrosine kinase inhibitor (TKI) therapy [1,2,3,4,5]. Clinical guidelines recommend routine mutation testing and identification of EGFR mutations in all patients with NSCLC of non-squamous cell carcinoma (non-SCC) histology to identify who may benefit from approved EGFRTKIs [6,7,8]. Identification of T790M prompted development of different therapeutic strategies to overcome resistance to EGFR-TKIs
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