(74) A Real-World Effectiveness of Second-Line Osimertinib in NSCLC Patients: A Multi-Institutions Study in Taiwan

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 748

Presenting Author(s)

Hui-Yu Chen
– LinKou Chang Gung Memorial Hospital, Taoyuan City, Taiwan

Co-Author(s)

KAICHENG CHANG
– Chang Gung Memorial Hospital, Linkou, Gui Shan Qu, Taiwan
Shih-Chieh Shao, PhD candidate
– Pharmacist, Keelung Chang Gung Memorial Hospital, Tainan, Tainan, Taiwan (Republic of China)
Yueh-Fu Fang
– Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taoyuan, Taiwan (Republic of China)

Background: Osimertinib, a third-generation Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI), was approval as second-line treatment for non-small cell lung cancers (NSCLC) patients with T790M mutation. However, the best prognostic factors, especially for the class of first-line EGFR-TKIs, are still inconclusive while the patients received osimertinib in the real-world clinical practices.

Objectives: To analyzed the real-world effectiveness and prognostic factors for overall survival (OS) and time to treatment failure (TTF) in the patients with second-line osimertinib.

Methods: We conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records data in Taiwan. We included NSCLC patients newly receiving osimertinib as second-line EGFR-TKI from January 1, 2020 to December 31,2020. The study outcomes included OS and TTF. We follow the patients from initiating osimertinib to the occurrence of interest outcomes, death, loss of follow up or end of data (December 31, 2021), whichever came first. Prognostic factors for outcomes included patients’ demographics (e.g., sex and age), Charlson comorbidity index (CCI), first-line EGFR-TKIs, metastatic status, stage, Eastern Cooperative Oncology Group (ECOG) and experience of chemotherapy between first-line failure and osimertinib start date. Uni-variable and multi-variables Cox regression model were applied to identify the prognostic factors.

Results: We included a total of 286 NSCLC patients with newly receiving osimertinib as a second-line EGFR-TKI with a median age of 66.8 years (range: 58.8-73.1), of whom 61.5% were female. We found afatinib as first-line treatment, duration of first-line ≥ 1 year and without chemotherapy between first-line failure and osimertinib period were significantly related to better OS in the uni-variable analyses. Moreover, afatinib as first-line treatment and without chemotherapy between first-line failure and osimertinib period were significantly related to better OS in the multi-variables analysis.

Conclusions: Afatinib as first-line EGFR-TKI was associated with better OS in NSCLC patients with osimertinib as second-line EGFR-TKI. Future real-world studies with large sample size and longer follow-up time are suggested to confirm our findings.