Real-World Testing Practices, Treatment Patterns and Clinical Outcomes in Patients from Central Eastern Europe with EGFR-Mutated Advanced Non-Small Cell Lung Cancer: A Retrospective Chart Review Study (REFLECT)

Urška Janžič, Nina Turnšek, Mircea Dediu, Ivan Shterev Donev, Roxana Lupu, Gabriela Teodorescu, Tudor E Ciuleanu, Adam Pluzanski, Urška Janžič, Nina Turnšek, Mircea Dediu, Ivan Shterev Donev, Roxana Lupu, Gabriela Teodorescu, Tudor E Ciuleanu, Adam Pluzanski

Abstract

The targeted therapy with tyrosine kinase inhibitors (TKIs) against the epidermal growth factor receptor mutation (EGFRm) in advanced non-small cell lung cancer (NSCLC) changed the treatment paradigm. REFLECT study (NCT04031898) explored EGFR/T790M testing and treatment patterns in EGFRm NSCLC patients receiving first- or second-generation (1G/2G) EGFR TKIs as front-line (1L) in eight countries. Pooled data from Central Eastern Europe (CEE) countries from this study (Bulgaria, Poland, Romania, Slovenia) are presented here. This physician-led chart review study was conducted in patients with confirmed-EGFRm NSCLC initiating 1L 1G/2G EGFR TKIs between 2015-2018. The CEE cohort included 389 patients receiving 1L erlotinib (37%), afatinib (34%), and gefitinib (29%). Overall, 320 (82%) patients discontinued 1L, and 298 (77%) progression events were registered. Median progression free survival on 1L TKIs was 14.0 (95% CI: 12.6-15.6) months. Median overall survival from 1L start was 26.6 (95% CI: 24.1-29.0) months. Attrition rate between 1L and next line was 30%. Among patients with 1L progression, 200 (67%) were tested for T790M and 58% were positive. This first CEE analysis of treatments and outcomes in EGFRm NSCLC patients highlights the importance of using the most efficacious therapies currently available in 1L to reduce attrition and improve patient outcomes.

Keywords: EGFR T790M mutation; advanced non-small cell lung cancer; real-world retrospective study.

Conflict of interest statement

U.J. declares honoraria (self) from AstraZeneca, Boehringer Ingelheim, MSD, Roche, Pfizer, and honoraria (institution) from AstraZeneca, Boehringer Ingelheim, MSD, Roche, Pfizer, Novartis, BMS; N.T. declares honoraria (self) from AstraZeneca, BMS, Boehringer Ingelheim, MSD, Pfizer, Roche, and honoraria (institution) from AstraZeneca, BMS, Boehringer Ingelheim, MSD, Novartis, Pfizer, Roche; M.D. declares honoraria for consultancy and speaking fee from Astellas, AstraZeneca, Aventis, Amgen, BMS, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, Servier; I.S.D. declares honoraria (self) from AstraZeneca, MSD, Roche, Pfizer; T.E.C. declares honoraria for advisory/consultancy from AD Pharma, Amgen, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi, Servier; A.P. declares honoraria (self) from AstraZeneca, BMS, Boehringer Ingelheim, MSD, Roche; R.L. and G.T. are AstraZeneca employees and have been involved in the review of the manuscript and in the decision to publish the results.

Figures

Figure 1
Figure 1
Treatment distribution in EGFRm NSCLC patients across first-, second- and third-lines of therapy. Note: multiple therapies could have been selected in one patient. a targeted therapy besides afatinib, erlotinib or gefitinib. 1L, first line therapy; 2L, second line therapy; 3L, third line therapy; N, number of patients initiating each therapy line; n, number of patients receiving specific treatments; ChemoT, chemotherapy; EGFRm, epidermal growth factor receptor mutation; IO, immunotherapy; NSCLC, non-small cell lung cancer; TT, targeted therapy; -, not applicable at the time of our study.
Figure 2
Figure 2
Reasons to discontinue first-, second- and third-line of therapy and attrition rates. Notes: Due to rounding, percentages may not always be 100%. a Deceased patients on each specific line have been excluded from the count. 1L, first line therapy; 2L, second line therapy, 3L, third line therapy; N, number of patients initiating each therapy line.

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