Lung cancer has the highest incidence and mortality among all cancers, with a 5-year survival rate of 15%. Presently, epidermal growth factor receptor (EGFR) mutation is the most common type of gene mutations detected in patients (pts) with advanced non-small-cell lung cancer, and EGFR is identified as the therapeutic target of EGFR tyrosine kinase inhibitors (TKIs). EGFR-TKIs have become the standard treatment. However, the most of the trials were developed in Asian countries, with a lack of data in western population.
This retrospective study aimed to review the medical records of EGFR- mutant advanced lung adenocarcinoma (LA) undergoing EGFR-TKIs treatment from 2015 to 2021, so as to examine the association of clinical factors with EGFR-TKI efficacy.
Of the 53 stage IV LA pts enrolled in this study, 9 were treated with more than one TKI. The mean age was 74,2 years old, 32 pts were non-smoker females and 38 had ECOG-PS 0-1. The mutations del19 or 21 L861G were the most frequent (23 and 20 pts respectively). The 20 T790M mutation was detected in 6 pts. First-line TKI (Gefitinib, Afatinib, Erlotinib and Osimertinib) were used in 26 pts and prior chemotherapy was preferred in 29 pts. A 24% objective response rate (ORR) and 67% disease control rate were observed for EGFR-TKIs treatment in all lines. Higher ORR was seen in patients with 0/1 ECOG scores than those with 2 or greater scores (p=0.046). The subjects had a progression free survival (PFS) of 17,8 months (p<0,01; 95% CI:12.9-22.84) and an overall survival (OS) of 27,5 months (p<0.01; 95% CI: 18.27-36.823). The median PFS was longer in pts treat with first-line TKI (p=0.029). The multivariate analysis indicated that ECOG-PS (p=0.04) and bone metastasis (p=0.036) were independent prognostic factors for OS.
The EGFR-TKI therapy results in survival benefits for EGFR-mutant advanced LA patients. ECOG-PS and bone metastasis were independent prognostic factors for OS.
Hospital Professor Doutor Fernando Fonseca.
Has not received any funding.
All authors have declared no conflicts of interest.