Continuing EGFR-TKI beyond radiological progression in patients with advanced or recurrent, EGFR mutation-positive non-small-cell lung cancer: an observational study

Abstract

BackgroundSome patients with advanced or recurrent, epidermal growth factor receptor (EGFR) mutation-positive (EGFR M+) non-small-cell lung cancer (NSCLC) continue to receive EGFR tyrosine kinase inhibitors (TKIs) beyond radiological progression.MethodsWe analysed a cohort of 577 patients with EGFR M+ NSCLC, who had received a first-line EGFR-TKI. We classified patients according to clinical course and treatment patterns at Response Evaluation Criteria in Solid Tumors (RECIST) progressive disease (PD). We evaluated the period from RECIST PD to TKI discontinuation or clinical PD and also evaluated survival after RECIST PD and compared it between groups.ResultsRECIST PD was documented in 451 cases, of which 283 (62.7%) were clinically stable. 186 (65.7%) discontinued and 97 (34.3%) continued the EGFR-TKI. In those who continued EGFR-TKI, median time between RECIST PD and clinical PD or TKI discontinuation was 5.1 months. Median survival after RECIST PD in patients who discontinued and continued EGFR-TKI after clinically stable RECIST PD was 14.6 and 15.3 months (p=0.5489), respectively. In multivariate analysis, continuing EGFR-TKI therapy, female gender, better performance status and exon 19 deletion subtype were likely positive predictive factors for survival after clinically stable RECIST PD.ConclusionOur study suggests that some patients could benefit from receiving an EGFR-TKI beyond radiological progression.

Combination TS‐1 plus EGFR‐tyrosine kinase inhibitors (TKIs) for the treatment of non‐small cell lung cancer after progression on first‐line or further EGFR‐TKIs: A phase II, single‐arm trial

“…However, their definition of progressive disease depended on the judgment of the attending physician, not RECIST as used in our study. In addition, the median OS of 31.9 months observed in our study was much longer than their result of 15.3 months OS …”

“…In addition, the median OS of 31.9 months observed in our study was much longer than their result of 15.3 months OS. 25 Because the efficacy of continuous EGFR-TKI monotherapy is relatively moderate, many studies have evaluated the efficacy of EGFR-TKIs combined with other agents, such as chemotherapy, antiangiogenic drugs, or monoclonal antibodies. In the real world, many patients receive pemetrexed plus platinum chemotherapy and achieve PFS of 4.9-5.4 months and OS of 16.1-19.5 months after they develop symptomatic resistance to EGFR-TKI treatment.…”

Mixed response to osimertinib and the beneficial effects of additional local therapy

“…The continuation of EGFR‐TKIs after radiological progression remains controversial . However, a subset of patients can benefit from the continuation of EGFR‐TKIs . Patients who exhibited an MR to osimertinib had several tumor lesions that remained sensitive to osimertinib.…”

From Diagnostic-Therapeutic Pathways to Real-World Data: A Multicenter Prospective Study on Upfront Treatment for EGFR-Positive Non-Small Cell Lung Cancer (MOST Study)

“…Moreover, continuation of EGFR TKI after progression in asymptomatic patients might delay treatment switch, providing some benefit in the overall strategy, as confirmed by some observational studies and the phase II ASPIRATION trial .…”

“…Oligoprogression frequently occurs in cases of oncogene-addicted NSCLC, and the benefit of TKI continuation during local ablative treatment on the sites of disease progression has emerged over the years [25][26][27]. Moreover, continuation of EGFR TKI after progression in asymptomatic patients might delay treatment switch, providing some benefit in the overall strategy, as confirmed by some observational studies and the phase II ASPIRATION trial [28,29].…”