AstraZeneca, Gaithersburg, Maryland, USA.
IQVIA, Durham, North Carolina, USA.
Cancer Med. 2023 Jan;12(1):159-169. doi: 10.1002/cam4.4918. Epub 2022 Jun 15.
Several epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) have been approved for first-line (1L) treatment of EGFR-mutated metastatic non-small cell lung cancer (mNSCLC) in the United States (US). Real-world analyses of 1L treatment patterns with EGFR TKIs, including the third-generation EGFR TKI osimertinib which was most recently approved in 2018, are still sparse.
This retrospective observational study used data from IQVIA's prescription claims (LRx) and medical claims (Dx) databases. mNSCLC patients newly treated with any EGFR TKI in the 1L setting were identified from January 1, 2015 to April 30, 2020; the first date of EGFR TKI (third-generation osimertinib, first-generation [erlotinib, gefitinib], or second-generation [afatinib, dacomitinib]) was the index date. Treatment patterns were reported in the cohorts stratified by 1L EGFR TKI.
A total of 2505 patients were included in the study (982 osimertinib, 1060 first-generation, and 463 second-generation EGFR TKI). Beginning in 2018, osimertinib became the most common 1L EGFR TKI (66.7%) and in early 2020, it accounted for 90.6% of 1L EGFR TKIs. Nearly all patients (>97%) were treated with 1L EGFR TKI monotherapy. Patients with 1L osimertinib had longer treatment duration compared to patients with 1L first- or second-generation EGFR TKI (median months: 17.8 vs. 8.7 vs. 10.5, respectively; log-rank test for comparisons with osimertinib p < 0.0001) over median follow-up times of 9.8, 20.5, and 19.3 months. 32.5% and 36.3% of the first- and second-generation EGFR TKI cohorts, respectively, had evidence of 2L treatment. Osimertinib monotherapy accounted for the majority of 2L treatments (58.3%/60.7%) and 11.3%/8.9% had 2L chemotherapy or immuno-oncology therapy following 1L first- or second-generation EGFR TKI.
In this real-world study of a US claims database, 1L treatment duration was longer with osimertinib compared with other EGFR TKIs. Future studies with longer follow-up are recommended to understand treatment patterns after progression on EGFR TKIs.
在美国，已有多种表皮生长因子受体酪氨酸激酶抑制剂（EGFR TKI）获批用于治疗 EGFR 突变型转移性非小细胞肺癌（mNSCLC）的一线治疗（1L）。对于第一代 EGFR TKI 奥希替尼（于 2018 年最新获批）在内的 1L 治疗方案的真实世界分析仍较为匮乏。
本回顾性观察性研究利用了 IQVIA 的处方索赔（LRx）和医疗索赔（Dx）数据库的数据。于 2015 年 1 月 1 日至 2020 年 4 月 30 日期间，在 1L 环境下新接受任何一种 EGFR TKI 治疗的 mNSCLC 患者被确定为研究对象；以首次接受 EGFR TKI（第三代奥希替尼、第一代[厄洛替尼、吉非替尼]或第二代[阿法替尼、达克替尼]）的日期作为索引日期。按照 1L EGFR TKI 分层报告治疗方案。
本研究共纳入 2505 例患者（奥希替尼 982 例，第一代 1060 例，第二代 463 例）。自 2018 年起，奥希替尼成为最常用的 1L EGFR TKI（66.7%），并于 2020 年初，其在 1L EGFR TKI 中的占比达到 90.6%。几乎所有患者（>97%）均接受了 1L EGFR TKI 单药治疗。与接受 1L 第一代或第二代 EGFR TKI 治疗的患者相比，接受 1L 奥希替尼治疗的患者的治疗持续时间更长（中位数月数：17.8 与 8.7 与 10.5；与奥希替尼相比，对数秩检验 p<0.0001），中位随访时间分别为 9.8、20.5 和 19.3 个月。第一代和第二代 EGFR TKI 队列中分别有 32.5%和 36.3%的患者接受了二线治疗。奥希替尼单药治疗在二线治疗中占大多数（58.3%/60.7%），11.3%/8.9%的患者在接受 1L 第一代或第二代 EGFR TKI 后接受了二线化疗或免疫肿瘤治疗。
在这项来自美国索赔数据库的真实世界研究中，与其他 EGFR TKI 相比，奥希替尼的 1L 治疗持续时间更长。建议开展随访时间更长的研究，以了解 EGFR TKI 治疗进展后的治疗方案。
