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Journal of Cancer Research and Clinical Oncology

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18-09-2021 | NSCLC | Original Article – Clinical Oncology

A comprehensive prognostic analysis of osimertinib treatment in advanced non-small cell lung cancer patients with acquired EGFR-T790M mutation: a real-world study

Authors: Xin Tang, Yuan Li, Wen-lei Qian, Wei-feng Yan, Tong Pang, You-ling Gong, Zhi-gang Yang

Published in: Journal of Cancer Research and Clinical Oncology | Issue 9/2022

Abstract

Purpose

Osimertinib is the standard treatment for advanced non-small cell lung cancer (NSCLC) patients with T790M mutation after the failure of first-/second-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). We comprehensively analyzed factors that affect the therapeutic efficacy of the osimertinib treatment in NSCLC patients.

Methods

351 NSCLC patients with T790M mutation receiving osimertinib treatment were included. We investigated the value of different factors in predicting the clinical outcomes of the osimertinib therapy, including progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). Logistic and COX regression were used to identify prognosticators.

Results

In osimertinib therapy, EGFR mutation status (19Del/L858R) at initial diagnosis and the therapeutic choice of prior EGFR-TKI agent was not associated with patients’ prognosis. Notably, the PFS of the prior EGFR-TKI was independently related to ORR (OR, 95% CI 0.98, 0.96–1.00, p = 0.030), PFS (HR, 95% CI 0.98, 0.97–1.00, p = 0.009) and OS (HR, 95% CI 0.96, 0.93–0.98, p < 0.001) of osimertinib treatment. Among distinct organ metastases, only bone metastasis was related to the efficacy of osimertinib, in terms of ORR (OR, 95% CI 1.97, 1.27–3.06, p = 0.002), PFS (HR, 95% CI 1.55, 1.18–2.03, p = 0.001) and OS (HR, 95% CI 1.81, 1.27–2.59, p = 0.001). However, the therapeutic efficacy of osimertinib was not further impacted by the accumulation of metastatic organs. A performance status score of 2–4 was also an adverse prognosticator for the osimertinib therapy.

Conclusion

PFS of the prior EGFR-TKI treatment, performance status score and bone metastasis were independent prognosticators of the osimertinib treatment. These findings may facilitate clinicians in the decision-making of osimertinib.

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Title: A comprehensive prognostic analysis of osimertinib treatment in advanced non-small cell lung cancer patients with acquired EGFR-T790M mutation: a real-world study
Authors: Xin Tang
Yuan Li
Wen-lei Qian
Wei-feng Yan
Tong Pang
You-ling Gong
Zhi-gang Yang
Publication date: 18-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: NSCLC
Metastasis
NSCLC
Bone Metastasis
Gefitinib
Osimertinib
Published in: Journal of Cancer Research and Clinical Oncology / Issue 9/2022
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-021-03797-y

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