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A.C. Lueers
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P3.01 - Advanced NSCLC (ID 621)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.01-038 - Impact on OS and PFS of 2nd and 3rd Generation TKI in EGFR Mt+ and ALK+ Patients: Results of the NOWEL Network (ID 9338)
09:30 - 09:30 | Author(s): A.C. Lueers
- Abstract
Background:
EGFR TKI treatment is standard of care in patients with metastasized NSCLC carrying an activating EGFR mutation. Targeted therapies achieve a higher ORR, OS, PFS and a better quality of life than chemotherapy. With the advent of 2[nd] and 3[rd] generation TKI´s effective in 1[st] generation TKI resistant tumors, we wanted to study the impact of these drugs on the outcome of patients in a real life setting in 3 lung cancer centers.
Method:
1473 patients from three cancer centers diagnosed with non-squamous cell NSCLC stage IV (UICC 7) were examined. Methods for the mutation testing was performed according to the German Oncopedia guidelines using either Sanger Sequencing or COBAS ® or Next Generation Sequencing.
Result:
964/1473 (65%) consecutive patients with non-squamous cell NSCLC were studied for the presence of tumor mutations. The EGFR mutation rate was 16% (147/943), and the ALK-translocation rate 4% (26/695). Median OS in EGFR mt+ patients was 27 months (n=147) compared to 11 months (n=796) in patients with EGFR WT (p<0.000). Median OS in EGFR mt+ patients depending on the center was 27 (n=95) vs. 28 (n=38) vs. 16 (n=14) months respectively (center 1 vs. center 2 vs. center 3). Median OS in ALK mt+ patients was 24 months (n=19) in center 1 and 11 months (n=5) in center 2 (p<0.025). The ORR in the CR/PR group was 54.2% for patients treated with chemotherapy and 77% for patients treated with TKI on 1[st] line therapy. The chance to reach a CR/PR is 2.83 higher for patients on TKI than for patients on chemotherapy (p<0.02). The use of 3[rd] generation TKI Osimertinib (n=19) lead to a significantly higher OS (n=19, median OS 67 months) than the use of only 1[st] and 2[nd] generation TKI (n=119, median OS 23 months, p<0.000). The hazard ratio for patients treated without Osimertinib was 4.66 [95% CI 2.006-10.81] (p<0.000). Patients treated with 3[rd] gen TKI had significantly longer PFS (11 months, n=7) than patients treated without (5 months, n=20) (p<0.037). Similarly, use of 2[nd] and 3[rd] generation ALKi impacted significantly on median OS: Crizotinib alone (n=8) 17 months, Crizotinib followed by Ceritinib and/or Brigatinib/Alectinib (n=12) median OS not reached and 3 months for other therapies (n=6) (p<0.000).
Conclusion:
Small differences in OS were observed, depending on the treatment centers, but the use of multiple EGFR and ALK-I impacted highly significantly on the outcome of patients with EGFR and ALK-alterations in a real life setting.
