Abstract
The impact of different first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI)s to the clinical efficacy of osimertinib in EGFR-mutant non-small-cell lung cancer (NSCLC) patients with acquired T790M was still unclear. We enrolled 733 advanced EGFR-mutant NSCLC patients with gefitinib, erlotinib or afatinib as first-line EGFR-TKIs treatment for analysis. 373 patients received re-biopsies after progressive disease to first-line EGFR-TKIs treatment, and the total positive rate of T790M was 51.7%. 151 patients who harbored T790M received osimertinib as subsequent treatment. Among them, the median progression-free survival (PFS) of first-line EGFR-TKI (PFS1) was 14.0 months, and the median PFS of osimertinib (PFS2) was 10.1 months. The median PFS1 + PFS2 was 27.5 months, and the median overall survival from first-line EGFR-TKI was 61.3 months. Concerning different first-line EGFR-TKIs, the median PFS2 was 10.9 months in the gefitinib group, 10.0 months in the erlotinib group, and 6.7 months in the afatinib group (p = 0.534). The median PFS1 + PFS2 was 27.7 months, 26.8 months and 24.0 months in the gefitinib, erlotinib, and afatinib group, respectively (p = 0.575). In conclusion, both first-generation and second-generation EGFR-TKIs sequential osimertinib treatment provided good clinical efficacy in advanced EGFR-mutant NSCLC patients with acquired T790M mutation.
Highlights
Non-small-cell Lung Cancer (NSCLC) accounts for 80–85% of the patients with lung c ancer[1]
Our research has demonstrated that advanced Epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) patients with first-line afatinib treatment displayed better progression-free survival (PFS) than patients with gefitinib or erlotinib use (PFS1)
The present study has proved the real-world efficacy of osimertinib in EGFR-mutant NSCLC patients with progressive disease to first-line EGFRTKIs who harbored T790M after rebiopsy
Summary
Non-small-cell Lung Cancer (NSCLC) accounts for 80–85% of the patients with lung c ancer[1]. Several clinical trials have proved that EGFR-mutant advanced NSCLC patients with first-generation (gefitinib and erlotinib) and second-generation (afatinib) EGFR-TKI treatment experienced longer progression-free survival (PFS) and fewer adverse effects than those patients who underwent platinum-based chemotherapy[7,8,9]. According to previous clinical trials, most of patients had acquired resistance 8 to 13 months later after first-line, first- and second-generation EGFR-TKIs use. The third-generation EGFR-TKI can overcome T790M mutation, and provide significantly longer PFS than standard platinum-based chemotherapy in advanced T790M-positive NSCLC patients who had acquired resistance to first-line EGFR-TKI treatment[16]
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