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Kiyoshi Komuta



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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-19 - Real World Data in Non-Small Cell Lung Cancer with Activating EGFR Mutation - A Multicenter Observational Study (ID 689)

      10:15 - 18:15  |  Author(s): Kiyoshi Komuta

      • Abstract

      Background

      Osimertinib demonstrated durable responses in patients with advanced non-small cell lung cancer (NSCLC) harboring major epidermal growth factor receptor (EGFR) mutations (EGFRm+) and T790M resistance mutation (T790M+) in global trials, and approved in March 2016 in Japan. The best treatment strategy of EGFR tyrosine kinase inhibitors (TKIs), especially osimertinib, cytotoxic drugs, and immune checkpoint inhibitors (ICIs) is unknown.

      Method

      To evaluate treatment selection with special attention to osimertinib, medical records of the patients with advanced EGFRm+ NSCLC who were under treatments at May 2016 or started a new treatment after May 2016 were collected.

      Result

      A total of 543 patients were collected. Median age 69 years (range: 35 to 90); female 67%; never smokers 60%; adenocarcinoma 99%; major EGFR mutations 94%; interstitial lung diseases (ILD) 5%. The first line regimen was started between September 2002 and August 2018. The median total number of regimens was 2 (range: 1 to 13). EGFR-TKIs were administered to all patients, and were rechallenged in 56%; 42% received platinum combination regimens. The median overall survival and the median duration of EGFR-TKI treatments were 85 and 40 months, respectively. Re-biopsy was performed 1 to 6 times for 296 patients, T790M was detected in 47% of them. Osimertinib were used in 167 patients including 7 patients in whom an 1st EGFR-TKI was switched to osimertinib without PD. The median treatment line of osimertinib was 3 (range: 1 to 10), the response rate and the disease control rate of osimetinib was 44% and 71%, respectively, and the median time to treatment failure (TTF) was 13 months while 52% were censored. Osimertinib-induced ILD developed in 4 patients, and one patient died. Sixty-two patients received once or twice ICI treatments: nivolumab, pembrolizumab, and atezolizumab were administered to 38, 19 and 7 patients, respectively. The ICIs-induced ILD developed in 1 patient with nivolumab. The median TTF of ICIs was 2.3 months (range: 0 to 29), the response rate and the disease control rate were 14% and 53%, respectively, and 9% could continue ICI for one year or more.

      Conclusion

      Re-biopsy was performed in 55%, and T790M was detected in 47%. In T790M+ including de novo T790M+ patients, osimertinib was used in 94%. Although this analysis has some limitations especially in patient selection, long-term survivors received platinum combination regimens, other cytotoxic drugs, and ICIs in addition to EGFR-TKIs.