Real-world management of patients with epidermal growth factor receptor (EGFR) mutation-positive non–small-cell lung cancer in the USA

Li, Yulin; Appius, Anita; Pattipaka, Thirupathi; Feyereislova, A.; Cassidy, Adrian; Ganti, Apar Kishor

doi:10.1371/journal.pone.0209709

Cited by 48 publications

(51 citation statements)

References 27 publications

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“…Expedited progress in lung cancer mortality likely reflects improved treatment because incidence rates decreased steadily from 2008 to 2017 by about 2.2% to 2.3% per year based on cancer registry data covering 69% of the US population 7 . These findings are also consistent with a recent SEER analysis by Howlader et al, who also examined stage at diagnosis and found no evidence of a shift to earlier diagnosis, suggesting little impact of lung cancer screening on population‐based mortality trends, likely due to low adherence 80,81 . In contrast to steady incidence trends, the 2‐year relative survival rate for lung cancer increased from 30% during 2009 through 2010 to 36% during 2015 through 2016.…”

Section: Selected Findingssupporting

confidence: 88%

Cancer Statistics, 2021

Siegel

Miller

Fuchs

et al. 2021

CA A Cancer J Clinicians

13,873

10,557

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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population‐based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long‐term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one‐half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%‐2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2‐year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.

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Section: Selected Findingssupporting

confidence: 88%

Cancer Statistics, 2021

Siegel

Miller

Fuchs

et al. 2021

CA A Cancer J Clinicians

13,873

10,557

View full text Add to dashboard Cite

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“…Li et al . (2019) report on a cohort of 22,258 patients with NSCLC from the US Flatiron Electronic Health Record database, of whom 961 met inclusion criteria 32 . Their examination of the overall population of NSCLC patients treated with bevacizumab revealed no significant differences in overall survival with respect to treatment type, similar to our finding of modest survival benefit resulting from the use of bevacizumab in the Medicare population of NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab for the treatment of non-small cell lung cancer patients with synchronous brain metastases

Ascha

Wang

Kumthekar

et al. 2019

Sci Rep

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Bevacizumab is FDA-approved in the treatment of primary brain tumors, but its efficacy in patients with brain metastases could be better-studied. This study examines a population of non-small cell lung cancer (NSCLC) patients with synchronous brain metastases to identify predictors of the decision to use bevacizumab and survival following bevacizumab treatment. Primary cancer registry data were used to determine which NSCLC patients diagnosed in the years 2010 through 2012 had synchronous brain metastases at the time of diagnosis, and Medicare claims used to identify a population of patients treated with bevacizumab. Record of bevacizumab treatment was found for 81 and 666 patients with and without brain metastases, respectively. After adjusting for clinical and demographic characteristics, bevacizumab was associated with 0.88 times the hazard of mortality in the elderly NSCLC population (95% CI: 0.81–0.96, p: 0.003) and a corresponding hazard ratio of 0.75 in the population of elderly NSCLC patients with synchronous brain metastases (95% CI: 0.59–0.96, p: 0.020). Bevacizumab may benefit NSCLC patients with synchronous brain metastases more than it does patients without intracranial disease, possibly as a result of its multiple potential mechanisms of action simultaneously inhibiting angiogenesis and minimizing vasogenic edema.

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“…De novo T790 M mutations have been found to co-exist at a low frequency in EGFR-TKI treatment-naïve patients with EGFRm positive NSCLC [53,54]; these are rarely seen by standard genotyping methods, occurring in 3.5% of patients [55]. However, with the introduction of highly sensitive assays, the frequency of de novo T790 M mutation in EGFR-TKI-naïve patients has been shown to range from 22% to 80% [56][57][58][59][60].…”

Section: Mechanisms Of Resistance To First-and Second-generation Egfrmentioning

confidence: 99%

“…However, in a US study only 38% of patients with NSCLC treated with a first-or secondgeneration EGFR-TKI received a subsequent treatment [98]. In a recent analysis of treatment patterns from the US Flatiron Electronic Health Record-derived database, 44% of patients with EGFRm positive advanced NSCLC received second-line treatment [55].…”

Section: )mentioning

confidence: 99%

Optimizing the sequencing of tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC)

Gelatti¹,

2019

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Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 80-85% of cases. Epidermal growth factor receptor (EGFR) mutations are observed in approximately 40% and 20% of patients with NSCLC in Asian and non-Asian populations, respectively. First-generation (gefitinib, erlotinib) and second-generation (afatinib, dacomitinib) EGFR-tyrosine kinase inhibitors (TKIs) have been standard-of-care (SoC) first-line treatment for patients with sensitizing EGFR mutation positive advanced NSCLC following Phase III trials versus platinum-based doublet chemotherapy. However, most patients treated with first-line first-or second-generation EGFR-TKIs develop resistance. Osimertinib, a third-generation, central nervous system active EGFR-TKI which potently and selectively inhibits both EGFR-TKI sensitizing (EGFRm) and the most common EGFR T790 M resistance mutations, has shown superior efficacy versus first-generation EGFR-TKIs (gefitinib / erlotinib). Osimertinib is now a treatment option for patients with advanced NSCLC harboring EGFRm in the first-line setting, and treatment of choice for patients with T790 M positive NSCLC following disease progression on first-line EGFR-TKIs. The second-generation EGFR-TKI dacomitinib has also recently been approved for the first-line treatment of EGFRm positive metastatic NSCLC. There remains a need to determine appropriate sequencing of EGFR-TKIs in this setting, including EGFR-TKIs as monotherapy or in combination with other TKIs / signaling pathway inhibitors. This review considers the evolving role of sequencing treatments to maximize benefits for patients with EGFRm positive advanced NSCLC.

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Real-world management of patients with epidermal growth factor receptor (EGFR) mutation-positive non–small-cell lung cancer in the USA

Cited by 48 publications

References 27 publications

Cancer Statistics, 2021

Cancer Statistics, 2021

Bevacizumab for the treatment of non-small cell lung cancer patients with synchronous brain metastases

Optimizing the sequencing of tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC)

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