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A comprehensive prognostic analysis of osimertinib treatment in advanced non-small cell lung cancer patients with acquired EGFR-T790M mutation: a real-world study

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Osimertinib is the standard treatment for advanced non-small cell lung cancer (NSCLC) patients with T790M mutation after the failure of first-/second-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). We comprehensively analyzed factors that affect the therapeutic efficacy of the osimertinib treatment in NSCLC patients.

Methods

351 NSCLC patients with T790M mutation receiving osimertinib treatment were included. We investigated the value of different factors in predicting the clinical outcomes of the osimertinib therapy, including progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). Logistic and COX regression were used to identify prognosticators.

Results

In osimertinib therapy, EGFR mutation status (19Del/L858R) at initial diagnosis and the therapeutic choice of prior EGFR-TKI agent was not associated with patients’ prognosis. Notably, the PFS of the prior EGFR-TKI was independently related to ORR (OR, 95% CI 0.98, 0.96–1.00, p = 0.030), PFS (HR, 95% CI 0.98, 0.97–1.00, p = 0.009) and OS (HR, 95% CI 0.96, 0.93–0.98, p < 0.001) of osimertinib treatment. Among distinct organ metastases, only bone metastasis was related to the efficacy of osimertinib, in terms of ORR (OR, 95% CI 1.97, 1.27–3.06, p = 0.002), PFS (HR, 95% CI 1.55, 1.18–2.03, p = 0.001) and OS (HR, 95% CI 1.81, 1.27–2.59, p = 0.001). However, the therapeutic efficacy of osimertinib was not further impacted by the accumulation of metastatic organs. A performance status score of 2–4 was also an adverse prognosticator for the osimertinib therapy.

Conclusion

PFS of the prior EGFR-TKI treatment, performance status score and bone metastasis were independent prognosticators of the osimertinib treatment. These findings may facilitate clinicians in the decision-making of osimertinib.

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Funding

This work was supported by the National Natural Science Foundation of China [Grant numbers NSFC30900360].

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Author notes

  1. Xin Tang and Yuan Li contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Xin Tang, Yuan Li, Wen-lei Qian, Wei-feng Yan, Tong Pang & Zhi-gang Yang

  2. Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    You-ling Gong

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  1. Xin Tang
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  2. Yuan Li
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Contributions

Conceptualization, methodology, and formal analysis: XT, YL, and YG; data curation and investigation: XT, YL, WQ, WY, and TP; supervision: ZY and YG; writing—original draft: XT and YL; writing—review and editing: XT, YL, YG, and ZY; final approval of the manuscript: all authors.

Corresponding authors

Correspondence to You-ling Gong or Zhi-gang Yang.

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This retrospective study was approved by the ethics committee of West China Hospital.

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432_2021_3797_MOESM1_ESM.pdf

Supplementary Fig. S1. Kaplan–Meier curves showing the progression-free survival (A) and overall survival (B) of patients with different number of metastatic extrathoracic organs (PDF 255 KB)

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Tang, X., Li, Y., Qian, Wl. et al. A comprehensive prognostic analysis of osimertinib treatment in advanced non-small cell lung cancer patients with acquired EGFR-T790M mutation: a real-world study. J Cancer Res Clin Oncol 148, 2475–2486 (2022). https://doi.org/10.1007/s00432-021-03797-y

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