O12. Survival of patients with advanced EGFR-mutated NSCLC treated with EGFR TKIS in routine clinical practice
Nina Turnsek Hitij1, Aleksander Sadikov2, Lea Knez1, Katja Mohorcic1, Andraz Jakelj1, Tanja Cufer1
Background: The use of epidermal growth factor receptor (EGFR) TKIs in EGFR-mutated non-small cell lung cancer (NSCLC) moved the survival boundary for these patients up to impressive 19 to 35 months, as reported in seven randomized clinical trials (RCTs). In addition, latest results of RCTs show significantly different outcomes for patients with exon 19 deletion and L858R mutation. To find out whether efficacy of EGFR TKIs is comparable in routine clinical practice, the overall survival (mOS) analysis of consecutive advanced EGFR-mutated patients routinely treated with EGFR TKIs from January 2010 to December 2013 in one academic institution was performed.
Patients and methods: EGFRmu status was determined by PCR (Therascreen®; Quiagen and Cobas®; Roche), 70 pts with 33/70 (47.1%) del19, 26/70 (37.1%) L858R mutations and 11/70 (15.7%) other mutations were included. Majority of pts 68/70 (97.1%) received EGFR TKI as first line systemic treatment, 2/70 (2.9%) received chemotherapy before EGFR TKI. 14/70 (20.0%) pts received EGFR TKI beyond progression on TKI. mOS was calculated from diagnosis to death or last follow up.
Results: In all 70 pts mOS of 22.0 (95% CI: 15.8-28.3) months was achieved. Patients harbouring common mutations (n=59) had mOS of 22.4 months (95% CI: 17.96-26.91), without significant difference in mOS rates observed between del19 and L858R (P=0.737). There was a trend toward better response rate (RR) for del19 compared to L858R (87% vs. 72%, P=0.155). The groups were balanced according to gender, age, smoking status, comorbidity, PS and number of TKI lines. Though limited in number (n=14), patients who received EGFR TKI beyond progression on TKI had significantly longer mOS than 56 patients who received only one line of EGFR TKI, 28.9 months (95% CI: 11.6-21.8) vs. 16.7 months (95% CI: 14.5-43.4, P=0.043), respectively.
Discussion: Based on our results, the mOS rates of EGFR-mutated advanced NSCLC pts treated with EGFR TKIs in a routine clinical practice are highly comparable to the results obtained in the frame of RCTs. Treatment with EGFR TKI beyond progression on TKI was embarked only lately and resulted into even higher mOS rates.
Keywords: Non-small cell lung cancer (NSCLC); epidermal growth factor receptor (EGFR) mutations; tyrosine kinase inhibitors
doi: 10.3978/j.issn.2218-6751.2014.AB011
