The most effective regimen has yet to be determined for patients with EGFR-mutated non–small cell lung cancer after progression on an EGFR-tyrosine kinase inhibitor. But chemotherapy regimens remain standard.
Chemotherapy regimens have been known to produce favorable outcomes among patients with EGFR-mutated non–small cell lung cancer (NSCLC) after progression on EGFR-tyrosine kinase inhibitor (TKI).1
According to a multicohort study, median progression-free survival (PFS) was not significantly different between first-line chemotherapy regimens (P = .50). The highest PFS was seen with platinum-based chemotherapy plus pemetrexed (PP) at 5.2 months (95% CI, 4.5-5.9) and the combination of carboplatin, paclitaxel, bevacizumab (Avastin), and atezolizumab (Tecentiq; CPBA) at 5.9 months (95% CI, 3.8-80).
Patients with EGFR-mutated NSCLC who were treated with chemotherapy regimens containing paclitaxel or pemetrexed after progression on an EGFR-TKI were identified in 2 tertiary centers in the Netherlands and eligible for inclusion in the study.
There were 135 patients eligible for inclusion. Ninety-six (71.1%) patients had previously received treatment with osimertinib (Tagrisso) upfront (n = 8) or after prior first- or second-generation EGFR-TKI (n = 88), and 33 patients received more than 1 line of chemotherapy.
A total of 171 lines of chemotherapy were identified, including PP (n = 95), CPBA (n = 32), paclitaxel/bevacizumab (PB, n = 36), and carboplatin/paclitaxel/bevacizumab (CPB, n = 8). There were 106 lines from the 171 given as first-line after EGFR-TKI, of which the majority (n = 76, 71.7%) were PP, followed by CPBA (n = 22, 20.8%).
Among patients, the baseline characteristics of the first-line cohort showed that the median age was 63 years (range, 33-80), most patients were female (61.3%), and most had never smoked (57.5%). Additionally, the majority of patients in this cohort harbored EGFR exon 19 deletions (51.9%) and EGFR exon 21 L858R mutations (30.2%) and had a concomitant TP53 aberration at baseline (67.0%).
At time of data cutoff, the median follow-up was 48.4 months (95% CI, 31.5-65.4) in the in the first-line cohort, and there were 105 events of progression, and 93 deaths. Treatment discontinuation resulting from toxicity was highest in the PB cohort (41.6%). This was followed by PP (21.1%), and CPBA (12.5%). No patients in the CPB cohort discontinued treatment due to toxicities.
In the first-line cohort, the median PFS was 5.4 months (95% CI, 4.7-6.1). This did not differ between the different types of EGFR mutations (p = .59), as well as between those with or without concomitant TP53 mutations (p = .11). In patients with CNS metastases in the first-line cohort, the median PFS was similar between those given PP at 4.8 months (95% CI, 2.3-7.3), and those given CPBA at 3.8 months (95% CI, 0.5-7.5; p = .67). In this cohort, 44 patients (41.5%) experienced durable benefits, and patients with durable benefit had less known CNS metastasis prior to start of chemotherapy compared with patients without durable benefit (20.5% v 43.5%; p = 0.01). Additionally, most patients given PB (n = 32) were given the regimen in a second- or later line and had a median PFS of 4.9 months (95% CI, 3.3-6.6).
The median OS for the first-line regimens was 15.3 months (95% CI, 11.60-18.9), and there was no significant difference between regimens (p = .85). Among patients with CNS metastases, the median OS was longer for patients given PP at 11.8 months (95% CI, 7.5-16.1) vs CPBA at 8.7 months (95% CI, 6.9-10.4). However, these findings did not meet statistical significance (p = .08).
Further, the ORR and DCR were not significantly different between the first-line regimens (p = .27 v p = .59, respectively). However, ORR differed significantly between the treatment regimens (p = .02), as PP had the worse ORR at 40.0% (95% CI, 30.1-50.6).
In the PB cohort, most patients (88.9%) were given the regimen as a second- or later line of treatment. Their median PFS of 4.9 months (95% CI, 3.3-6.6), and 9 patients who experienced disease progression as best overall response on PP, subsequently received PB. Seven of the 9 patients (77.8%) achieved disease control with the PB regimen, 1 patient showed stable disease and had a PFS of 8.2 months, and 6 patients had a partial response with a PFS ranging from 3.2-8.3 months.
Overall, each of these chemotherapy regimens provided a survival benefit after treatment with an EGFR-TKI, and the most effective regimen has yet to be determined.
REFERENCE:
Steendam CMJ, Ernst SM, Badrising SK, et al. Chemotherapy for patients with EGFR-mutated NSCLC after progression on EGFR-TKI's: Exploration of efficacy of unselected treatment in a multicenter cohort study. Lung Cancer. 2023;181:107248. doi:10.1016/j.lungcan.2023.107248
FDA Clears Lazertinib/Amivantamab for First-Line EGFR-Mutated NSCLC
August 20th 2024Lazertinib and amivantamab as a first-line treatment for patients with locally advanced or metastatic non–small cell lung cancer with specific EGFR mutations demonstrated superior efficacy compared with standard treatment.
Read More
Osimertinib Offers New Standard of Care in Stage III EGFR-Mutated NSCLC
August 6th 2024Suresh S. Ramalingam, MD, discussed the practice-changing findings and implications of the phase 3 LAURA study investigating osimertinib for the treatment of patients with EGFR-mutated non–small cell lung cancer.
Read More