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Observational Study of Treatment Patterns in Patients with Epidermal Growth Factor Receptor (EGFR) Mutation-Positive Non-Small Cell Lung Cancer After First-Line EGFR-Tyrosine Kinase Inhibitors

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Abstract

Introduction

Epidermal growth factor receptor (EGFR) mutations are observed in approximately 15% of patients with non-small cell lung cancer (NSCLC) in the USA. Little is known about treatment patterns in EGFR mutation-positive NSCLC following progression on or after first-line (1L) treatment with first- or second-generation EGFR tyrosine kinase inhibitors (EGFR-TKIs). Osimertinib, a third-generation EGFR-TKI, is a treatment option for patients with EGFR T790M-positive NSCLC following progression on 1L EGFR-TKIs. This study analyzed real-world treatment sequencing of EGFR-TKIs, EGFR T790M testing rates, and disposition of patients with EGFR mutations after 1L EGFR-TKI post-FDA approval of osimertinib in patients with EGFR mutation-positive NSCLC.

Methods

Adult patients with stage IV NSCLC and documented EGFR mutation-positive status were identified between December 1, 2015 and May 31, 2017 from the US Oncology Network iKnowMed™ electronic health record (EHR). Data were abstracted from the EHR database and supplemented by chart review.

Results

Of 308 patients, 302 (98%) received an EGFR-TKI overall, and 246 patients (80%) received a 1L EGFR-TKI. The most common 1L EGFR-TKI was erlotinib (66%); the remaining 1L regimens were predominantly combination chemotherapies with or without an EGFR-TKI. Only 80 patients (26%) received any 2L therapy. The most common EGFR-TKIs used as 2L monotherapy in patients who received 1L EGFR-TKI were afatinib and osimertinib (n = 7 for both). Among all patients treated with 1L EGFR-TKI (n = 246), 47 (19%) were tested for EGFR T790M [16 patients (34%) were positive], 48 (20%) remained on 1L EGFR-TKI, 29 (12%) received subsequent therapy, 38 (15%) had died on or after their 1L EGFR-TKI therapy, and 131 (53%) stopped their EGFR-TKI with no recorded evidence of having received subsequent therapy at follow-up end.

Conclusion

Following 1L EGFR-TKI treatment, 19% of patients were tested for EGFR T790M, and most (69%) had no record of receiving any subsequent therapy.

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Acknowledgements

Funding

Sponsorship for this study and the journal’s Rapid Service Fee were funded by AstraZeneca. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Medical Writing and Editorial Assistance

The authors would like to acknowledge Robert Harrison, PhD, of iMed Comms, Macclesfield, UK, an Ashfield Company, part of UDG Healthcare plc, for technical editing support that was funded by AstraZeneca in accordance with Good Publications Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Eric Nadler reports a consulting or advisory role for Merck, and participation in speaker bureaus for Merck, Genentech and AstraZeneca. Melissa Pavilack and Ancilla Fernandes are AstraZeneca employees and shareholders. Janet Espirito and Jamyia Clark are McKesson employees and shareholders.

Compliance with Ethics Guidelines

Institutional Review Board approval and waiver of authorization was obtained for the study.

Data Availability

Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data sharing policy described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.

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Authors and Affiliations

  1. US Oncology Health Informatics and Internet Technology, Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA

    Eric Nadler

  2. Health Economics and Outcomes Research, AstraZeneca US, Gaithersburg, MD, USA

    Melissa Pavilack & Ancilla Fernandes

  3. Outcomes Research, McKesson Life Sciences, The Woodlands, TX, USA

    Janet L. Espirito & Jamyia Clark

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  1. Eric Nadler
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  2. Melissa Pavilack
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  3. Janet L. Espirito
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  5. Ancilla Fernandes
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Corresponding author

Correspondence to Eric Nadler.

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Nadler, E., Pavilack, M., Espirito, J.L. et al. Observational Study of Treatment Patterns in Patients with Epidermal Growth Factor Receptor (EGFR) Mutation-Positive Non-Small Cell Lung Cancer After First-Line EGFR-Tyrosine Kinase Inhibitors. Adv Ther 37, 946–954 (2020). https://doi.org/10.1007/s12325-020-01221-4

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