Trends in Overall Survival in Lung Adenocarcinoma with EFGR Mutation, KRAS Mutation, or No Mutation.

BACKGROUND

Treatment of lung adenocarcinoma has changed and now includes checkpoint inhibitors (CPIs) or, in the case of an mutation, third-generation EGFR TKI osimertinib. Few data compare the long-term overall survival (OS) of current and historic subgroups.

METHODS

This real-world analysis (KOMPASS study) included stage IV lung-adenocarcinoma patients with either EGFR, KRAS, or no mutation. Patients were assigned to the "current" , , or no-mutation cohort if they had mutation testing using NGS ( = 199; median date of diagnosis 2021). If they had an EGFR PCR test only, they were assigned to the "historic" or no-mutation cohort ( = 127; median date of diagnosis 2014).

RESULTS

Both the current and the historic cohorts had significantly longer OS than the respective no-mutation cohorts (HR 0.58 and 0.60, respectively). The current no-mutation and cohorts had a strong trend to longer OS than the respective historic cohorts. In the no-mutation cohorts, the improvement was due to an increase in long-term survivors (HR 0.71), whereas in the mutation cohorts, the median OS was improved without long-term survivors (HR 0.70). The cohort showed OS like the no-mutation cohort, with a plateau of long-term survivors around 20%.

CONCLUSIONS

A comparison of our data with that of the phase III trials KEYNOTE-189 and FLAURA suggests that the improved outcomes are due to the use of CPIs or osimertinib. The clinical trial results are well translated into real-world clinical practice with comparable OS. patients benefit from CPI treatment like no-mutation patients.