First-line osimertinib in elderly patients with epidermal growth factor receptor-mutated advanced non-small cell lung cancer: a retrospective multicenter study (HOT2002)

Go Yamamoto ,Hajime Asahina ,Ryoichi Honda ,Takaaki Sasaki ,Kenichiro Ito ,Toshiyuki Sumi ,Hajime Kikuchi ,Yuka Fujita ,Fumihiro Hommura ,Ryo Morita ,Hiroshi Isobe ,Noriaki Sukoh ,Keiki Yokoo ,Yasuyuki Ikezawa ,Satoshi Oizumi ,Nozomu Kimura ,Atsushi Nakamura ,Toshiyuki Harada ,Hisashi Tanaka ,Hirotoshi Dosaka‐Akita ,Osamu Honjo ,Taichi Takashina ,Hirotoshi Akita

doi:10.1038/s41598-021-02561-z

Abstract

Osimertinib is a standard of care therapy for previously untreated epidermal growth factor receptor mutation-positive non-small cell lung cancer. However, limited data exist regarding the efficacy and safety of osimertinib as a first-line therapy for elderly patients aged 75 years or older. To assess the potential clinical benefits of osimertinib in this population, this retrospective multi-institutional observational study included 132 patients with non-small cell lung cancer (age ≥ 75 years), who received osimertinib as first-line treatment. The proportion of patients with 1-year progression-free survival was 65.8% (95% confidence interval 57.1–73.5). The median progression-free survival was 19.4 (95% confidence interval 15.9–23.9) months. The median overall survival was not reached (95% confidence interval 24.6–not reached). The frequency of pneumonitis was 17.4%, with a grade 3 or higher rate of 9.1%. More than two-thirds of treatment discontinuations due to pneumonitis occurred within 3 months of starting osimertinib, and the prognosis of patients with pneumonitis was unsatisfactory. Osimertinib is one of the effective first-line therapeutic options for patients aged 75 years or older; however, special caution should be exercised due to the potential development of pneumonitis.

Highlights

Osimertinib is a standard of care therapy for previously untreated epidermal growth factor receptor mutation-positive non-small cell lung cancer
We retrospectively evaluated the clinical outcomes in patients aged 75 years or older with advanced Non-small cell lung cancer (NSCLC) harboring EGFR-TKI-sensitizing mutations who received first-line osimertinib
Patients with performance status (PS) ≥ 2 had significantly more advanced stage and liver metastasis than those with PS 0–1, though there was no apparent difference in Charlson comorbidity index (CCI) (Supplementary Table S1)

Summary

Introduction

Osimertinib is a standard of care therapy for previously untreated epidermal growth factor receptor mutation-positive non-small cell lung cancer. To assess the potential clinical benefits of osimertinib in this population, this retrospective multi-institutional observational study included 132 patients with non-small cell lung cancer (age ≥ 75 years), who received osimertinib as first-line treatment. A previous phase II study of patients with T790M mutation resistance to first-line EGFR-TKIs reported comparable efficacy and safety of osimertinib between non-elderly patients and those over 75 years of age[12]. To this end, we retrospectively evaluated the clinical outcomes in patients aged 75 years or older with advanced NSCLC harboring EGFR-TKI-sensitizing mutations who received first-line osimertinib

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Conclusion