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Thorac Cancer: Survival comparison of NSCLC patients with EGFR-T790M mutation, follow-up treatment with osimertinib in different orders

 Last Update: 2021-12-03
 Source: Internet
 Author: User

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At present , when patients with advanced NSCLC are accompanied by EGFR-T790M mutations, the standard treatment is the third-generation EGFR-TKI osimertinib
.

For patients with T790M mutation after treatment with the first/second representative skin growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), the benefits of subsequent treatment with osimertinib in different sequences are still unclear

At present , when patients with advanced NSCLC are accompanied by EGFR-T790M mutations, the standard treatment is the third-generation EGFR-TKI osimertinib

The study retrospectively screened 3807 patients diagnosed with cancer in Kaohsiung Chang Gung Memorial Hospital from 2013 to 2019
.

A total of 76 patients with EGFR-T790M mutation who received osimertinib after re-biopsy or liquid biopsy were included in the analysis

The study retrospectively screened 3807 patients diagnosed with cancer in Kaohsiung Chang Gung Memorial Hospital from 2013 to 2019

The EGFR genotyping at the first diagnosis showed that there were Del 19 and L858R mutations in 42 (55.

Among the 76 patients, 40 (52.

The median PFS of patients who received osimertinib after first-line treatment with gefitinib, afatinib, or erlotinib were 12.

There was no difference in ORR between A and B groups (63.
9% vs 42.
5%, p = 0.
063), but there was a difference in DCR (94.
4% vs 77.
5%, p = 0.
036)
.

There were no significant differences in PFS (15.

There was no difference in ORR between A and B groups (63.

Subgroup analysis showed that for PFS, significant differences were observed in the following factors: patients received EGFR-TKI treatment for ≥1 month (p = 0.
042, HR = 0.
55, 95%CI = 0.
31-0.
98), low BMI (p = 0.
042, HR = 0.
73, 95% CI 0.
99 = 0.
54), no chronic obstructive pulmonary disease (COPD) (p = 0.
005, HR = 0.
36, 95% CI = 0.
17-0.
75)
.

OS was only significantly different in patients without COPD (p = 0.

Subgroup analysis showed that for PFS, significant differences were observed in the following factors: patients received EGFR-TKI treatment for ≥1 month (p = 0.

Eleven patients (27.
5%) in group B had brain metastases before osimertinib treatment; PFS of patients with brain metastases before osimertinib treatment was 10.
27 months, and PFS of patients without brain metastases was 11.
37 months
.
Therefore, osimertinib as a third-line treatment of PFS is better than second-line treatment
.

In group A, 10 patients (27.
8%) had brain metastases before osimertinib treatment; the PFS of patients with brain metastases before osimertinib treatment was 11.
07 months, and the PFS of patients without brain metastases was 16.
90 months
.
Eleven patients (27.
5%) in group B had brain metastases before osimertinib treatment; PFS of patients with brain metastases before osimertinib treatment was 10.
27 months, and PFS of patients without brain metastases was 11.
37 months
.
Therefore, osimertinib as a third-line treatment of PFS is better than second-line treatment
.
Ositinib as a third-line treatment of PFS is better than second-line treatment
.

The researchers also studied the difference in survival between patients with L858R and Del19 mutations
.
Among L858R-positive patients, there was no significant difference in PFS between group A and group B (12.
57 months vs.
9.
00 months, p = 0.
189)
.
In addition, among del19-positive patients, there was no significant difference in PFS between group A and group B (21.
13 months vs.
11.
87 months, p = 0.
884)
.
However, patients with positive L858R and del19 in group A had longer PFS
.

In summary, studies have shown that in patients with T790M mutation after the 1/2 generation EGFR-TKI treatment progresses, chemotherapy can affect the efficacy of subsequent osimertinib treatment
.

Original source:

Wang CC, Lai CH, Chang YP, Chang HC, Tseng CC, Huang KT, Lin MC.
Comparing survival and treatment response of patients with acquired T790M mutation second-line osimertinib versus sequential treatment of chemotherapy followed by osimertinib: A real-world study .
Thorac Cancer.
2021 Oct 26.
doi: 10.
1111/1759-7714.
14198.
Epub ahead of print.
PMID: 34704378.

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