Robinson Nathaniel D, Canavan Maureen E, Zhan Peter L, Udelsman Brooks V, Pathak Ranjan, Boffa Daniel J, Goldberg Sarah B
Yale University School of Medicine, New Haven, CT.
Keck School of Medicine of University of Southern California, Los Angeles, CA.
Clin Lung Cancer. 2025 Jan;26(1):9-17.e3. doi: 10.1016/j.cllc.2024.09.006. Epub 2024 Sep 23.
For patients with advanced epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) who progress on first-line osimertinib, the optimal second-line treatment regimen after progression is not known. We sought to assess practice patterns and evaluate the association between different therapies and survival in patients with EGFR-mutated NSCLC following progression on first-line osimertinib.
Retrospective cohort study of patients who received first-line treatment with osimertinib using a population-based, multicenter nationwide electronic health record-derived deidentified database.
We identified 2373 patients who received first-line osimertinib. The majority (n = 2279) received osimertinib monotherapy. A total of 538 patients received first-line osimertinib and had second-line treatment data available. Second-line treatment regimens were varied: 65% (n = 348) included chemotherapy, 37% (n = 197) included an immune checkpoint inhibitor (ICI), and 44% (n = 234) included an EGFR tyrosine kinase inhibitor (TKI). We then analyzed the 333 patients with performance status 0-2 who received chemotherapy with osimertinib (n = 107, 32%) versus chemotherapy without osimertinib (n = 226, 68%). The continuation of osimertinib with chemotherapy was associated with superior progression-free survival (PFS; median: 10.1 versus 5.9 months, Hazard Ratio [HR]: 0.48, 95% Confidence Interval [CI]: [0.34, 0.68], P < .001) and overall survival (OS; median: 17.0 versus 12.8 months, HR: 0.64, 95% CI: [0.44, 0.93], P = .018) compared to other chemotherapy approaches without osimertinib. This effect was most pronounced in patients with an EGFR exon 19 deletion.
Following progression on osimertinib, a wide variety of treatment regimens were used. The continuation of osimertinib with chemotherapy in the second line was associated with increased PFS and OS.
对于一线使用奥希替尼治疗后病情进展的晚期表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者，病情进展后的最佳二线治疗方案尚不清楚。我们旨在评估治疗模式，并评估一线使用奥希替尼治疗病情进展后的EGFR突变NSCLC患者中不同治疗方法与生存之间的关联。
使用基于人群的多中心全国性电子健康记录衍生的去识别数据库，对接受奥希替尼一线治疗的患者进行回顾性队列研究。
我们确定了2373例接受一线奥希替尼治疗的患者。大多数（n = 2279）接受奥希替尼单药治疗。共有538例患者接受了一线奥希替尼治疗并可获得二线治疗数据。二线治疗方案各不相同：65%（n = 348）包括化疗，37%（n = 197）包括免疫检查点抑制剂（ICI），44%（n = 234）包括EGFR酪氨酸激酶抑制剂（TKI）。然后，我们分析了333例体能状态为0 - 2且接受奥希替尼联合化疗（n = 107，32%）与不接受奥希替尼的化疗（n = 226，68%）的患者。与不使用奥希替尼的其他化疗方法相比，奥希替尼联合化疗与更好的无进展生存期（PFS；中位数：10.1个月对5.9个月，风险比[HR]：0.48，95%置信区间[CI]：[0.34, 0.68]，P <.001）和总生存期（OS；中位数：17.0个月对12.8个月，HR：0.64，95% CI：[0.44, 0.93]，P =.018）相关。这种效应在EGFR外显子19缺失的患者中最为明显。
奥希替尼治疗病情进展后，使用了多种治疗方案。二线使用奥希替尼联合化疗与PFS和OS的增加相关。
