Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC
Background: Osimertinib has been the standard of care in epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC). We evaluated outcomes between osimertinib and first/second-generation (1G/2G) EGFR-tyrosine kinase inhibitors (TKIs) as first-line (1L), and investigated how T7...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-09-01
|
| Series: | ESMO Real World Data and Digital Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949820124000365 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850178138151059456 |
|---|---|
| author | Y. Uehara Y. Takeyasu T. Yoshida A. Tateishi M. Torasawa Y. Hosomi K. Masuda Y. Shinno Y. Matsumoto Y. Okuma Y. Goto H. Horinouchi N. Yamamoto Y. Ohe |
| author_facet | Y. Uehara Y. Takeyasu T. Yoshida A. Tateishi M. Torasawa Y. Hosomi K. Masuda Y. Shinno Y. Matsumoto Y. Okuma Y. Goto H. Horinouchi N. Yamamoto Y. Ohe |
| author_sort | Y. Uehara |
| collection | DOAJ |
| description | Background: Osimertinib has been the standard of care in epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC). We evaluated outcomes between osimertinib and first/second-generation (1G/2G) EGFR-tyrosine kinase inhibitors (TKIs) as first-line (1L), and investigated how T790M status and sequential osimertinib after 1G/2G EGFR-TKI failure affected overall survival (OS). Materials and methods: We retrospectively evaluated the outcomes of patients with advanced NSCLC harboring exon 19 deletion or L858R mutation who received osimertinib and 1G/2G EGFR-TKIs as 1L treatment from January 2015 to March 2021. In the exploratory analysis, we analyzed the outcomes among three groups: osimertinib as 1L (1L-Osi), 1L 1G/2G EGFR-TKIs followed by osimertinib (2L-Osi), and 1L 1G/2G EGFR-TKIs without osimertinib (No-Osi). Propensity score matching (PSM) and 12-month landmark analysis were used to mitigate selection bias and immortal time bias. Results: Of 485 patients, 213 and 272 received 1L osimertinib and 1L 1G/2G EGFR-TKIs. All 2L-Osi patients had T790M mutations after 1G/2G EGFR-TKI failure. OS did not differ according to 1L EGFR-TKIs [osimertinib versus 1G/2G EGFR-TKIs; 33.7 versus 41.8 months; hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.65-1.29]. In the 12-month landmark analysis, the median OS was 34.4 months [95% CI 21.3 months-not reached (NR)] in 1L-Osi, 63.8 months (95% CI 46.0 months-NR) in 2L-Osi, and 22.5 months (95% CI 19.0-35.3 months) in No-Osi. After PSM, similar results were observed. Conclusions: There was no significant difference in OS between osimertinib and 1G/2G EGFR-TKIs as 1L treatment in patients with EGFR-mutant NSCLC. However, 2L osimertinib following 1L 1G/2G EGFR-TKIs in patients who would acquire T790M mutation has been linked to a better prognosis compared to 1L osimertinib. |
| format | Article |
| id | doaj-art-04cfceb66b4f470f9546ab5e5d9f29b0 |
| institution | OA Journals |
| issn | 2949-8201 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | ESMO Real World Data and Digital Oncology |
| spelling | doaj-art-04cfceb66b4f470f9546ab5e5d9f29b02025-08-20T02:18:48ZengElsevierESMO Real World Data and Digital Oncology2949-82012024-09-01510005810.1016/j.esmorw.2024.100058Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLCY. Uehara0Y. Takeyasu1T. Yoshida2A. Tateishi3M. Torasawa4Y. Hosomi5K. Masuda6Y. Shinno7Y. Matsumoto8Y. Okuma9Y. Goto10H. Horinouchi11N. Yamamoto12Y. Ohe13Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan; Department of Precision Cancer Medicine, Center for Innovative Cancer Treatment, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan; Correspondence to: Dr Tatsuya Yoshida, Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo 104-0051, Japan. Tel: +81-3-3542-2511.Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanDepartment of Thoracic Oncology, National Cancer Center Hospital, Tokyo, JapanBackground: Osimertinib has been the standard of care in epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC). We evaluated outcomes between osimertinib and first/second-generation (1G/2G) EGFR-tyrosine kinase inhibitors (TKIs) as first-line (1L), and investigated how T790M status and sequential osimertinib after 1G/2G EGFR-TKI failure affected overall survival (OS). Materials and methods: We retrospectively evaluated the outcomes of patients with advanced NSCLC harboring exon 19 deletion or L858R mutation who received osimertinib and 1G/2G EGFR-TKIs as 1L treatment from January 2015 to March 2021. In the exploratory analysis, we analyzed the outcomes among three groups: osimertinib as 1L (1L-Osi), 1L 1G/2G EGFR-TKIs followed by osimertinib (2L-Osi), and 1L 1G/2G EGFR-TKIs without osimertinib (No-Osi). Propensity score matching (PSM) and 12-month landmark analysis were used to mitigate selection bias and immortal time bias. Results: Of 485 patients, 213 and 272 received 1L osimertinib and 1L 1G/2G EGFR-TKIs. All 2L-Osi patients had T790M mutations after 1G/2G EGFR-TKI failure. OS did not differ according to 1L EGFR-TKIs [osimertinib versus 1G/2G EGFR-TKIs; 33.7 versus 41.8 months; hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.65-1.29]. In the 12-month landmark analysis, the median OS was 34.4 months [95% CI 21.3 months-not reached (NR)] in 1L-Osi, 63.8 months (95% CI 46.0 months-NR) in 2L-Osi, and 22.5 months (95% CI 19.0-35.3 months) in No-Osi. After PSM, similar results were observed. Conclusions: There was no significant difference in OS between osimertinib and 1G/2G EGFR-TKIs as 1L treatment in patients with EGFR-mutant NSCLC. However, 2L osimertinib following 1L 1G/2G EGFR-TKIs in patients who would acquire T790M mutation has been linked to a better prognosis compared to 1L osimertinib.http://www.sciencedirect.com/science/article/pii/S2949820124000365epidermal growth factor receptor (EGFR)-mutationfirst/second-generation EGFR-TKIosimertinibreal-world data |
| spellingShingle | Y. Uehara Y. Takeyasu T. Yoshida A. Tateishi M. Torasawa Y. Hosomi K. Masuda Y. Shinno Y. Matsumoto Y. Okuma Y. Goto H. Horinouchi N. Yamamoto Y. Ohe Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC ESMO Real World Data and Digital Oncology epidermal growth factor receptor (EGFR)-mutation first/second-generation EGFR-TKI osimertinib real-world data |
| title | Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC |
| title_full | Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC |
| title_fullStr | Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC |
| title_full_unstemmed | Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC |
| title_short | Real-world outcomes of treatment strategy between first-line osimertinib, first/second-generation EGFR-TKIs followed by osimertinib and without osimertinib in advanced EGFR-mutant NSCLC |
| title_sort | real world outcomes of treatment strategy between first line osimertinib first second generation egfr tkis followed by osimertinib and without osimertinib in advanced egfr mutant nsclc |
| topic | epidermal growth factor receptor (EGFR)-mutation first/second-generation EGFR-TKI osimertinib real-world data |
| url | http://www.sciencedirect.com/science/article/pii/S2949820124000365 |
| work_keys_str_mv | AT yuehara realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT ytakeyasu realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT tyoshida realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT atateishi realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT mtorasawa realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT yhosomi realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT kmasuda realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT yshinno realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT ymatsumoto realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT yokuma realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT ygoto realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT hhorinouchi realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT nyamamoto realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc AT yohe realworldoutcomesoftreatmentstrategybetweenfirstlineosimertinibfirstsecondgenerationegfrtkisfollowedbyosimertinibandwithoutosimertinibinadvancedegfrmutantnsclc |