P3.01-040 Real-World Management of Patients with EGFR Mutation-Positive NSCLC in the US


      Clinical trials have demonstrated the efficacy and safety of EGFR tyrosine kinase inhibitors (TKIs), as first-line therapy in patients with metastatic non-small-cell lung cancer (NSCLC) whose tumors harbor activating mutations in the EGFR gene. However, there are limited data in the real-world setting describing TKI use among patients with EGFR-mutated NSCLC.


      A retrospective non-interventional study was conducted using the Flatiron Health database, a longitudinal database containing electronic health record data, of patients seen in over 265 United States cancer clinics (∼800 sites of care). Adult patients with histologically confirmed stage IIIB or IV NSCLC, with documented EGFR-mutated disease (del 19 or L858R), and who had received the first sequence of systemic therapy between January, 2011 and March, 2016 were included. Patient demographic and clinical disease characteristics were analyzed and time-to-next treatment (TTNT) was used as a surrogate measure for progression-free survival. If validated in time, overall survival data will be presented.


      Overall 20,924 adult patients with advanced NSCLC were identified, of whom 12,148 (58.1 %) were tested for EGFR mutations. Among these, 1,919 (15.8 %) patients had a positive EGFR result with 1,412 patients carrying del 19 or exon 21 mutations. Of these, 886 patients were treated with regimens in the first-line setting. Median age was 69.0 years; 67.7% were female; 55.5% were Caucasian; 54.3% were non-smokers; 97.5% had non-squamous histology and 57.3% received at least one subsequent treatment. Most patients received a TKI (71.8%) and 28.2% received other therapy. There were no differences observed in a patient’s type of insurance and the type of treatment (TKI or chemotherapy) that they were likely to receive. Patients treated with an EGFR TKI had a significantly longer median TTNT [erlotinib (13.2 months [95% CI 12.2–14.4; p=<0.001]) afatinib (12.6 months [95% CI 8.6–16.2; p=<0.001]), gefitinib (not evaluable; due to small sample size n=9) than those treated with other anti-cancer agents (4.6 months [95% CI 4.0–5.4]).


      These real world data mirror the results shown in randomized clinical trials, with the exception of patients being generally older. Importantly, patients who did not receive a TKI had significantly shorter TTNT. A large proportion of patients (42%) are not being tested for EGFR mutations, although there was an improvement over time. The reasons for not testing all eligible patients for EGFR mutations should be investigated further.


      Erlotinb, Real-world data, Flatiron Health database