Addeo A, Hochmair M, Janzic U, Dudnik E, Charpidou A, Płużański A, Ciuleanu T, Donev IS, Elbaz J, Aarøe J, Ott R, Peled N. Treatment patterns, testing practices, and outcomes in the pre-FLAURA era for patients with EGFR mutation-positive advanced NSCLC: a retrospective chart review (REFLECT).
Ther Adv Med Oncol 2022;
13:17588359211059874. [PMID:
35173817 PMCID:
PMC8842149 DOI:
10.1177/17588359211059874]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction:
For epidermal growth factor receptor mutation-positive (EGFRm) non-small-cell
lung cancer (NSCLC), EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are the
preferred first-line (1 L) treatment in the advanced setting. Osimertinib, a
third-generation EGFR-TKI, received full approval in 2017 for second-line (2
L) treatment of EGFR T790M-positive NSCLC. The REFLECT study characterizes
real-world treatment/testing patterns, attrition rates, and outcomes in
patients with EGFRm advanced NSCLC treated with 1 L first-/second-generation
(1G/2G) EGFR-TKIs before 1 L osimertinib approval.
Methods:
Retrospective chart review (NCT04031898) of European/Israeli adults with
EGFRm unresectable locally advanced/metastatic NSCLC, initiating 1 L 1G/2G
EGFR-TKIs 01/01/15–30/06/18 (index date).
Results:
In 896 patients (median follow-up of 21.5 months), the most frequently
initiated 1 L EGFR-TKI was afatinib (45%). Disease progression was reported
in 81%, including 10% (86/896) who died at 1 L. By the end of study, most
patients discontinued 1 L (85%), of whom 33% did not receive 2 L therapy.
From index, median 1 L real-world progression-free survival was 13.0 (95%
confidence interval (CI): 12.3–14.1) months; median overall survival (OS)
was 26.2 (95% CI: 23.6–28.4) months. 71% of patients with 1 L progression
were tested for T790M; 58% were positive. Of those with T790M, 95% received
osimertinib in 2 L or later. Central nervous system (CNS) metastases were
recorded in 22% at index, and 15% developed CNS metastases during treatment
(median time from index 13.5 months). Median OS was 19.4 months (95% CI:
17.1–22.1) in patients with CNS metastases at index, 24.8 months (95% CIs
not available) with CNS metastases diagnosed during treatment, and 30.3
months (95% CI: 27.1, 33.8) with no CNS metastases recorded.
Conclusion:
REFLECT is a large real-world study describing treatment patterns prior to 1
L osimertinib availability for EGFRm advanced NSCLC. Given the attrition
rates highlighted in the study and the impact of CNS progression on
outcomes, offering a 1 L EGFR-TKI with CNS penetration may improve patient
outcomes in this treatment setting.
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