Osimertinib beyond disease progression in T790M EGFR-positive NSCLC patients: a multicenter study of clinicians’ attitudes

• A. Cortellini ^[4] ; A. Leonetti ^[5] ; A. Catino ^[6] ; P. Pizzutillo ^[6] ; B. Ricciuti ^[1] ; A. De Giglio ^[1] ; R. Chiari ^[7] ; P. Bordi ^[5] ; D. Santini ^[8] ; R. Giusti ^[9] ; M. De Tursi ^[10] ; D. Brocco ^[11] ; F. Zoratto ^[12] ; F. Rastelli ^[13] ; F. Citarella ^[8] ; M. Russano ^[8] ; M. Filetti ^[9] ; P. Marchetti ^[9] ; R. Berardi ^[2] ; M. Torniai ^[2] ; D. Cortinovis ^[14] ; E. Sala ^[14] ; C. Maggioni ^[14] ; A. Follador ^[15] ; M. Macerelli ^[15] ; O. Nigro ^[16] ; A. Tuzi ^[16] ; D. Iacono ^[17] ; M. R. Migliorino ^[17] ; G. Banna ^[18] ; G. Porzio ^[4] ; K. Cannita ^[3] ; M. G. Ferrara ^[19] ; E. Bria ^[19] ; D. Galetta ^[6] ; C. Ficorella ^[4] ; M. Tiseo ^[5]
  1. [1] Università di Perugia

     Università di Perugia

     Perusa, Italia

     
  2. [2] Marche Polytechnic University

     Marche Polytechnic University

     Ancona, Italia

     
  3. [3] University of L'Aquila

     University of L'Aquila

     L'Aquila, Italia

     
  4. [4] Medical Oncology Unit, St. Salvatore Hospital, Via Vetoio, L’Aquila, Italy
  5. [5] Medical Oncology, University Hospital of Parma, Italy
  6. [6] Thoracic Oncology Unit, Clinical Cancer Centre “Giovanni Paolo II”, Bari, Italy
  7. [7] Medical Oncology, Ospedali Riuniti Padova Sud “Madre Teresa Di Calcutta”, Monselice, Italy
  8. [8] Medical Oncology, Campus Bio-Medico University, Rome
  9. [9] Medical Oncology, Sant’Andrea Hospital, Rome
  10. [10] Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
  11. [11] Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
  12. [12] Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
  13. [13] Medical Oncology, Fermo Area Vasta 4, Fermo, Italy
  14. [14] Medical Oncology, Ospedale San Gerardo, Monza, Italy
  15. [15] Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
  16. [16] Medical Oncology, ASST-Sette Laghi, Varese, Italy
  17. [17] Pulmonary Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
  18. [18] Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
  19. [19] Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 22, Nº. 6, 2020, págs. 844-851
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Background In most cases, T790M EGFR-positive NSCLC patients receiving osimertinib developed “non-drugable” progression, as the patients with common EGFR-sensitizing mutations were treated with first-line osimertinib. In both settings, chemotherapy represents the standard treatment and local ablative treatments (LATs) are potential useful options in the case of oligo-progression.

    Methods We conducted a study on “post-progression” (pp) outcomes of T790M EGFR-positive NSCLC patients treated with osimertinib, according to the therapeutic strategy applied: osimertinib beyond progression (± LATs), “switched therapies” or best supportive care only (BSC).

    Results 144 consecutive patients were evaluated: 53 (36.8%) did not received post-progression treatments (BSC), while 91 (63.2%) patients received at least 1 subsequent treatment; 50 patients (54.9%) received osimertinib beyond disease progression [19 (20.9%) of them with adjunctive LATs] and 41 (45.1%) a switched therapy. Median ppPFS (progression-free survival) and median ppOS (overall survival) of patients who received osimertinib beyond progression vs. switched therapies were 6.4 months vs. 4.7 months, respectively [HR 0.57 (95% CI 0.35–0.92), p = 0.0239] and 11.3 months vs 7.8 months, respectively [HR 0.57 (95% CI 0.33–0.98), p = 0.0446]. Among patients who received osimertinib beyond progression with and without LATs median ppPFS was 6.4 months and 5.7 months, respectively [HR 0.90 (95% CI 0.68–1.18), p = 0.4560], while median ppOS was 20.2 months and 9.9 months, respectively [HR 0.73 (95% CI 0.52–1.03), p = 0.0748]. At the univariate analysis, the only factor significantly related to the ppPFS was the therapeutic strategy in favor of osimertinib beyond progression (± LATs). Moreover, the only variable which was significantly related to ppOS at the multivariate analysis was osimertinib beyond progression (± LATs).

    Conclusion Our study confirmed that in clinical practice, in case of “non-druggable” disease progression, maintaining osimertinib beyond progression (with adjunctive LATs) is an effective option.