Virtual Library

Start Your Search

Dieter Ukena



Author of

  • +

    P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P1.01-82 - Risk of Not Receiving 2nd Line Therapy is High in EGFR mt+ pts: Real World Data of Certified Lung Cancer Centers on Treatment Sequence in EGFR mt+ pts (ID 13238)

      16:45 - 18:00  |  Author(s): Dieter Ukena

      • Abstract
      • Slides

      Background

      Recently FLAURA study demonstrated significant PFS and numeric OS benefit for Osimertinib 1st line vs. 1st generation TKI’s Erlotinib/Gefitinib. The number of patients switching from 1st generation to 3rd gen. TKI (30%) appeared to be low and it is questionable whether these data represent real world sequencing treatment patterns. Therefore, we investigated the sequence pattern, i.e. the percentage of 2nd line therapy in EGFR mt+ patients in 3 certified lung cancer centers in Germany.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Data of 912 of 1477 patients tested for EGFR mutations (treated in Oldenburg, Bremen, Hamburg) were analyzed between 2009-2017. 140/144 patients with an activating EGFR mutation (16%) and treated with systemic therapy (4 patients received no therapy) were identified and their treatments were captured as well as their outcome. 36 patients were treated before accessibility to 3rd generation TKI and 104 patients after accessibility to 3rd generation TKI.

      4c3880bb027f159e801041b1021e88e8 Result

      130/140 patients were treated with 1st line TKI and 10 received 1st line chemotherapy. 17 patients are still on 1st line TKI, 8 patients were lost to follow-up, 3 patients died while on 1st line TKI. 112 patients were candidates for 2nd line therapy. 34/112 (30%) of these patients did not receive 2nd line therapy. Causes for not receiving 2nd line therapy were patients refusal (n=2), bad PS (n=26) frequently due to CNS metastases, fast progression and death (n=6). After accessibility of 3rd generation TKI, 20 of 66 (30%) patients did not receive 2nd line therapy. Median OS of the overall cohort was 27 months (n=140), median OS of patients receiving 2nd line (n=78) vs. no 2nd line (n=62) was 36 vs. 14 months (p<0.0001). After accessibility of 3rd generation TKI 30/104 patients (29%) receive a 3rd generation TKI after 1st line or 2nd line therapy. Median OS of patients receiving (n=30) and not receiving 3rd generation TKI (n=110) was 55 months vs. 22 months (p<0.0001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In real world, a significant number of patients treated with 1st or 2nd generation TKI do not reach 2nd line therapy even when 3rd generation TKI were accessible. Reasons for not receiving 2nd line therapy are in most cases deterioration of PS and lack of possibility to test for T790M in the minority of cases (n=28/66, 42% were not tested). These data, although favorable for the small and very selected cohort of patients treated with Osimertinib, might argue for the most effective therapy in 1st line for patients with EGFR mt+ tumors.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.