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Real-world efficacy of osimertinib in previously EGFR-TKI treated NSCLC patients without identification of T790M mutation.

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机构： [1]Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. [2]School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. [3]Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. [4]Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China. [5]Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA. [6]Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA. [7]Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China. [8]Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA. [9]Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA. [10]Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan. [11]Thoracic Disease Research Unit, Division of Pulmonary and Critical Care Medicine, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA. [12]Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA. [13]Developmental Therapeutics and Cell Biology Programs, Mayo Clinic Cancer Center, Rochester, MN, USA. [14]Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. [15]Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA [16]Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA.

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关键词： Lung cancer EGFR mutation T790M PD-L1 Osimertinib

摘要：

The efficacy of osimertinib in previously EGFR-TKI-treated NSCLC without identification of T790M mutational status remains unclear in real-world practice.417 patients had stage III-IV NSCLC harboring EGFR mutation and 154 out of 417 patients receiving osimertinib as ≥ second-line EGFR-TKI were identified. The time to treatment failure and risk of death were analyzed.Higher risk of death was found in EGFR-mutant patients with age ≥ 65 years, non-adenocarcinoma, no surgery or radiation, non-exon 19 deletion/exon 21 L858R, higher ECOG PS (2-4), PD-L1 expression ≥ 50%, and bone/liver/adrenal metastasis (all p < 0.05). Osimertinib as ≥ second-line TKI in patients with/without identification of T790M revealed lower risk of death compared to first-line first/second generation TKI without subsequent osimertinib (p = 0.0002; 0.0232, respectively). However, osimertinib-treated patients with T790M did not have superior survival than those without (p = 0.2803). A higher risk of treatment failure for osimertinib was found in males, patients with first-line TKI duration ≤ 12 months, BMI drop > 10%, and PD-L1 expression ≥ 50% (All p < 0.05). Nonetheless, osimertinib as ≥ second-line TKI in patients without identification of 790 M did not have higher risk of treatment failure than those with T790M (p = 0.1236).This study demonstrates that osimertinib as second line or subsequent TKI in EGFR-TKI-treated patients without identification of T790M revealed lower risk of death compared to first-line first/second generation TKI without subsequent osimertinib, in real-world practice. Additionally, EGFR-mutant patients with PD-L1 expression ≥ 50% had a higher risk of treatment failure for osimertinib and worse overall survival than those with PD-L1 expression < 50%. These results suggest that osimertinib as second line or subsequent TKI may be a potential alternative option for the treatment of patients without identification of T790M and PD-L1 expression ≥ 50% is associated with a significantly poor outcome in patients receiving osimertinib.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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出版当年[2021]版：

大类 | 3 区医学

小类 | 3 区肿瘤学

最新[2023]版：

大类 | 3 区医学

小类 | 4 区肿瘤学

第一作者：

第一作者机构： [1]Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. [2]School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. [3]Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

通讯作者：

通讯机构： [15]Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA [16]Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA.

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Real-world efficacy of osimertinib in previously EGFR-TKI treated NSCLC patients without identification of T790M mutation.

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