Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis
Introduction: Osimertinib is now a standard first-line (1L) therapy for EGFR-mutated (EGFRm) advanced NSCLC. We aimed to characterize patterns of therapy and longitudinal risk of brain and liver metastasis in a cohort of EGFRm NSCLC. Methods: Patients with metastatic EGFRm NSCLC who received 1L syst...
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2025-01-01
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| author | Margaret Stalker, MD Connor B. Grady, MPH Alex Watts, MS Wei-Ting Hwang, PhD Krishna Chandrasekhara, MS Fangdi Sun, MD Geoffrey Liu, MD Devalben Patel, MD Jorge Nieva, MD Amanda Herrmann, MD Kristen Marrone, MD Vincent K. Lam, MD Vamsidhar Velcheti, MD Stephen V. Liu, MD Gabriela Liliana Bravo Montenegro, MD William Tompkins, MD Tejas Patil, MD Jared Weiss, MD Kelsey Leigh Miller, MD William Schwartzman, MD Jonathan E. Dowell, MD Khvaramze Shaverdashvili, MD, PhD Liza Villaruz, MD Amanda Cass, PharmD Wade Iams, MD Dara Aisner, MD, PhD Charu Aggarwal, MD, MD D. Ross Camidge, MD, PhD Lova Sun, MD Melina E. Marmarelis, MD |
| author_facet | Margaret Stalker, MD Connor B. Grady, MPH Alex Watts, MS Wei-Ting Hwang, PhD Krishna Chandrasekhara, MS Fangdi Sun, MD Geoffrey Liu, MD Devalben Patel, MD Jorge Nieva, MD Amanda Herrmann, MD Kristen Marrone, MD Vincent K. Lam, MD Vamsidhar Velcheti, MD Stephen V. Liu, MD Gabriela Liliana Bravo Montenegro, MD William Tompkins, MD Tejas Patil, MD Jared Weiss, MD Kelsey Leigh Miller, MD William Schwartzman, MD Jonathan E. Dowell, MD Khvaramze Shaverdashvili, MD, PhD Liza Villaruz, MD Amanda Cass, PharmD Wade Iams, MD Dara Aisner, MD, PhD Charu Aggarwal, MD, MD D. Ross Camidge, MD, PhD Lova Sun, MD Melina E. Marmarelis, MD |
| author_sort | Margaret Stalker, MD |
| collection | DOAJ |
| description | Introduction: Osimertinib is now a standard first-line (1L) therapy for EGFR-mutated (EGFRm) advanced NSCLC. We aimed to characterize patterns of therapy and longitudinal risk of brain and liver metastasis in a cohort of EGFRm NSCLC. Methods: Patients with metastatic EGFRm NSCLC who received 1L systemic therapy at sites within the Academic Thoracic Medical Investigator’s Consortium were included; demographic and clinical data including treatment patterns were described. Analyses of overall survival, time to next treatment, and incident brain and liver metastasis were performed using the Kaplan-Meier method, Cox regression, and cumulative incidence functions on patients who started 1L therapy in 2015 or later. Results: The full cohort included 1132 patients and the mean age of the participants was 63.4 years; among the participants, 53% were White individuals, 68% were female individuals, and 67% were nonsmokers. Among the participants, 830 patients received 1L systemic therapy in 2015 or later. The predominant first EGFR–tyrosine kinase inhibitor was erlotinib (65%) before 2018 and osimertinib (81%) after 2018. The median time to the next treatment after the start of 1L therapy was 13.9 months overall and the longest in patients receiving 1L osimertinib (28 months). In the post-2015 cohort, the baseline prevalence of brain metastasis (BM) was 54% and among patients without baseline brain metastasis, the probability of incident BM at 12, 24, and 48 months was 8%, 22%, and 44%, respectively. Development of an on-treatment brain metastasis among patients without baseline brain metastasis was associated with a 3.2 times higher risk of death. Conclusion: Even in a contemporary era with prevalent osimertinib use, the baseline and longitudinal risk of BM development was high. The ongoing risk of developing BM, together with the associated survival detriment, argues for routine surveillance of the brain through magnetic resonance imaging for patients with EGFRm NSCLC, which is not currently included in the guidelines. |
| format | Article |
| id | doaj-art-6bef8139f60a47f296c740f696efb851 |
| institution | Kabale University |
| issn | 2666-3643 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj-art-6bef8139f60a47f296c740f696efb8512025-01-20T04:17:55ZengElsevierJTO Clinical and Research Reports2666-36432025-01-0161100765Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry AnalysisMargaret Stalker, MD0Connor B. Grady, MPH1Alex Watts, MS2Wei-Ting Hwang, PhD3Krishna Chandrasekhara, MS4Fangdi Sun, MD5Geoffrey Liu, MD6Devalben Patel, MD7Jorge Nieva, MD8Amanda Herrmann, MD9Kristen Marrone, MD10Vincent K. Lam, MD11Vamsidhar Velcheti, MD12Stephen V. Liu, MD13Gabriela Liliana Bravo Montenegro, MD14William Tompkins, MD15Tejas Patil, MD16Jared Weiss, MD17Kelsey Leigh Miller, MD18William Schwartzman, MD19Jonathan E. Dowell, MD20Khvaramze Shaverdashvili, MD, PhD21Liza Villaruz, MD22Amanda Cass, PharmD23Wade Iams, MD24Dara Aisner, MD, PhD25Charu Aggarwal, MD, MD26D. Ross Camidge, MD, PhD27Lova Sun, MD28Melina E. Marmarelis, MD29Department of Medicine, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corresponding author. Address for correspondence: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Phildaelphia, Pennsylvania, 3400 Spruce St, Phildadelphia, Pennsylvania 19104.Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDepartment of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDepartment of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDepartment of Medicine, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Hematology/Oncology, UCSF School of Medicine, University of California San Francisco, San Francisco, CaliforniaDivision of Hematology/Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, CanadaDivision of Hematology/Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, CanadaUniversity of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CaliforniaUniversity of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CaliforniaDivision of Hematology/Oncology, Johns Hopkins University School of Medicine, Baltimore, MarylandDivision of Hematology/Oncology, Johns Hopkins University School of Medicine, Baltimore, MarylandDivision of Hematology/Oncology, NYU Grossman School of Medicine, New York University, New York, New YorkLombardi Comprehensive Cancer Center, Georgetown University, Washington, DCLombardi Comprehensive Cancer Center, Georgetown University, Washington, DCDepartment of Medicine, Perelman School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Hematology/Oncology, University of Colorado Cancer Center, Aurora, ColoradoLineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North CarolinaLineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North CarolinaHarold C Simmons Comprehensive Cancer Center, UT Southwestern, Dallas, TexasHarold C Simmons Comprehensive Cancer Center, UT Southwestern, Dallas, TexasUPMC Hillman Cancer Center, Pittsburgh, PennsylvaniaUPMC Hillman Cancer Center, Pittsburgh, PennsylvaniaDivision of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TennesseeDivision of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TennesseeDivision of Hematology/Oncology, University of Colorado Cancer Center, Aurora, ColoradoDivision of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Hematology/Oncology, University of Colorado Cancer Center, Aurora, ColoradoDivision of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaIntroduction: Osimertinib is now a standard first-line (1L) therapy for EGFR-mutated (EGFRm) advanced NSCLC. We aimed to characterize patterns of therapy and longitudinal risk of brain and liver metastasis in a cohort of EGFRm NSCLC. Methods: Patients with metastatic EGFRm NSCLC who received 1L systemic therapy at sites within the Academic Thoracic Medical Investigator’s Consortium were included; demographic and clinical data including treatment patterns were described. Analyses of overall survival, time to next treatment, and incident brain and liver metastasis were performed using the Kaplan-Meier method, Cox regression, and cumulative incidence functions on patients who started 1L therapy in 2015 or later. Results: The full cohort included 1132 patients and the mean age of the participants was 63.4 years; among the participants, 53% were White individuals, 68% were female individuals, and 67% were nonsmokers. Among the participants, 830 patients received 1L systemic therapy in 2015 or later. The predominant first EGFR–tyrosine kinase inhibitor was erlotinib (65%) before 2018 and osimertinib (81%) after 2018. The median time to the next treatment after the start of 1L therapy was 13.9 months overall and the longest in patients receiving 1L osimertinib (28 months). In the post-2015 cohort, the baseline prevalence of brain metastasis (BM) was 54% and among patients without baseline brain metastasis, the probability of incident BM at 12, 24, and 48 months was 8%, 22%, and 44%, respectively. Development of an on-treatment brain metastasis among patients without baseline brain metastasis was associated with a 3.2 times higher risk of death. Conclusion: Even in a contemporary era with prevalent osimertinib use, the baseline and longitudinal risk of BM development was high. The ongoing risk of developing BM, together with the associated survival detriment, argues for routine surveillance of the brain through magnetic resonance imaging for patients with EGFRm NSCLC, which is not currently included in the guidelines.http://www.sciencedirect.com/science/article/pii/S2666364324001358EGFR NSCLCPractice patternsBrain metastasisGuidelines |
| spellingShingle | Margaret Stalker, MD Connor B. Grady, MPH Alex Watts, MS Wei-Ting Hwang, PhD Krishna Chandrasekhara, MS Fangdi Sun, MD Geoffrey Liu, MD Devalben Patel, MD Jorge Nieva, MD Amanda Herrmann, MD Kristen Marrone, MD Vincent K. Lam, MD Vamsidhar Velcheti, MD Stephen V. Liu, MD Gabriela Liliana Bravo Montenegro, MD William Tompkins, MD Tejas Patil, MD Jared Weiss, MD Kelsey Leigh Miller, MD William Schwartzman, MD Jonathan E. Dowell, MD Khvaramze Shaverdashvili, MD, PhD Liza Villaruz, MD Amanda Cass, PharmD Wade Iams, MD Dara Aisner, MD, PhD Charu Aggarwal, MD, MD D. Ross Camidge, MD, PhD Lova Sun, MD Melina E. Marmarelis, MD Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis JTO Clinical and Research Reports EGFR NSCLC Practice patterns Brain metastasis Guidelines |
| title | Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis |
| title_full | Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis |
| title_fullStr | Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis |
| title_full_unstemmed | Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis |
| title_short | Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated NSCLC: An Academic Thoracic Medical Investigator’s Consortium Registry Analysis |
| title_sort | changing treatment and metastatic disease patterns in patients with egfr mutated nsclc an academic thoracic medical investigator s consortium registry analysis |
| topic | EGFR NSCLC Practice patterns Brain metastasis Guidelines |
| url | http://www.sciencedirect.com/science/article/pii/S2666364324001358 |
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