Study of patient characteristics, treatment patterns, EGFR testing patterns and outcomes in real-world patients with EGFRm⁺ non-small cell lung cancer

Abstract

Objective

This retrospective, observational study examined patient characteristics, treatment patterns, testing patterns, and outcomes of US patients receiving first-/second- or third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs).

Methods

This study used an electronic health record-derived de-identified database. Eligible patients had advanced EGFRm⁺ non-small cell lung cancer. Descriptive statistics were used to describe demographic, clinical, and treatment characteristics. Logistic regression models were used to identify patient characteristics that were associated with the use of osimertinib vs. a first-/second-generation EGFR TKI. Kaplan–Meier methods were used for survival analysis.

Results

Of the 782 patients who received first-line (1L) therapy with first-/second-generation EGFR TKIs in cohort A, erlotinib was the most common (58%), and osimertinib was the most widely prescribed second-line (2L) therapy (52%). Of the patients who received 1L therapy with osimertinib, a greater range of treatments were prescribed in 2L. A third of patients treated with first-/second-generation EGFR TKIs underwent EGFR testing near the end of 1L, and 44% of these patients had T790M positive disease. The median time on targeted therapy (TTT) of the cohort was 11.1 months (95% confidence interval [CI] 9.7, 12.3), and the median overall survival from the start of 1L therapy was 23.5 months (95% CI 20.7, 24.8).

Conclusions

The majority of patients treated with first-/second-generation EGFR TKIs went on to receive osimertinib in the 2L setting, but overall, only a third of patients had received molecular testing at progression. Improved testing frequency is vital to inform treatment decisions.

Keywords:

• NSCLC
• real-world data
• EGFR
• TKI
• treatment pattern
• survival outcomes

Transparency

Declaration of funding

This manuscript was sponsored by Eli Lilly and Company.

Declaration of financial/other relationships

K.B.W., K.M.S, and Z.L.C. are current employees and shareholders of Eli Lilly and Company. T.S. is a current employee of Syneos Health. J.F. has received funding from AstraZeneca, Bristol Myers Squibb, and has been an advisory board member and/or consultant for AstraZeneca, Bristol Myers Squibb, Genentech, Eli Lilly and Company, Merck, and Pfizer.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors participated in the drafting, critical revision, and approval of the final version of the manuscript.

Acknowledgements

Medical writing assistance was provided by Ella Lineham, PhD, of ProScribe – Envision Pharma Group, and was funded by Eli Lilly and Company. ProScribe’s services complied with international guidelines for Good Publication Practice (GPP3).

Data availability statement

The data that support the findings of this study have been originated by Flatiron Health, Inc. These de-identified data may be made available upon request, and are subject to a license agreement with Flatiron Health; interested researchers should contact <[email protected]> to determine licensing terms.