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. 2022 Aug 14;56(3):371-379.
doi: 10.2478/raon-2022-0025.

Real-world outcomes, treatment patterns and T790M testing rates in non-small cell lung cancer patients treated with first-line first- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors from the Slovenian cohort of the REFLECT study

Nina Turnsek  1 , Rok Devjak  1   2 , Natalija Edelbaher  3 , Ilonka Osrajnik  3 , Mojca Unk  1 , Dusanka Vidovic  3 , Tina Jeric  4 , Urska Janzic  5
Affiliations

Real-world outcomes, treatment patterns and T790M testing rates in non-small cell lung cancer patients treated with first-line first- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors from the Slovenian cohort of the REFLECT study

Nina Turnsek et al. Radiol Oncol. .

Abstract

Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective treatments for EGFR mutation-positive (EGFRm) non-small cell lung cancer (NSCLC). However, routine clinical practice is different between countries/institutions.

Patients and methods: The REFLECT study (NCT04031898) is a retrospective medical chart review that explored real-life treatment and outcomes of EGFRm NSCLC patients receiving first-line (1L) first-/second-generation (1G/2G) EGFR TKIs in 8 countries. This study included adult patients with documented advanced/metastatic EGFRm NSCLC with 1L 1G/2G EGFR TKIs initiated between Jan 2015 - Jun 2018. We reviewed data on clinical characteristics, treatments, EGFR/T790M testing patterns, and survival outcomes. Here, we report data from 120 medical charts in 3 study sites from Slovenia.

Results: The Slovenian cohort (median age 70 years, 74% females) received 37% erlotinib, 32% afatinib, 31% gefitinib. At the time of data collection, 94 (78%) discontinuations of 1L TKI, and 89 (74%) progression events on 1L treatment were reported. Among patients progressing on 1L, 73 (82%) were tested for T790M mutation yielding 50 (68%) positive results, and 62 (85%) received 2L treatment. 82% of patients received osimertinib. Attrition rate between 1L and 2L was 10%. The median (95% CI) real-world progression free survival on 1L EGFR TKIs was 15.6 (12.6, 19.2) months; median overall survival (95% CI) was 28.9 (25.0, 34.3) months.

Conclusions: This real-world study provides valuable information about 1G/2G EGFR TKIs treatment outcomes and attrition rates in Slovenian EGFRm NSCLC patients. The reduced attrition rate and improved survival outcomes emphasize the importance of 1L treatment decision.

Keywords: T790M testing; attrition; epidermal growth factor receptor; non-small cell lung cancer; real-world study.

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Figures

Figure 1
Figure 1
(A) Kaplan-Meier curves for median real-world progression free survival on first-line (1L) epidermal growth factor (EGFR) tyrosine kinase inhibitors (TKIs) therapy. (B) Kaplan-Meier curves for median overall survival from start of 1L EGFR TKI therapy. Censored patients are indicated with a cross. CI = confidence interval; OS = overall survival; rwPFS = real-world progression-free survival
Figure 2
Figure 2
Treatment patterns patients in with locally advanced or metastatic epidermal growth factor receptor mutated (EGFRm) non-small cell lung cancer (NSCLC) treated with first-line (1L) first-/second-generation (1G/2G) EGFR tyrosine kinase inhibitors (TKIs). Note that multiple treatments could have been administered at each line of treatment. * Targeted therapy besides afatinib, erlotinib, gefitinib and osimertinib (1L: not specified; 3L: crizotinib); 2L = second-line; 3L =third-line; IO = immuno-oncology
Figure 3
Figure 3
Attrition rates at first-line (1L), second-line (2L) and third-line (3L) in patients with locally advanced or metastatic epidermal growth factor receptor mutated (EGFRm) non-small cell lung cancer (NSCLC).
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