Real-World Treatment Patterns, Epidermal Growth Factor Receptor (EGFR) Testing and Outcomes in EGFR-Mutated Advanced Non-small Cell Lung Cancer Patients in Belgium: Results from the REVEAL Study

Kristof Cuppens, Liesbet Lodewyckx, Ingel Demedts, Lore Decoster, Benoît Colinet, Koen Deschepper, Annelies Janssens, Daniella Galdermans, Thierry Pieters, REVEAL Study Group, Lynn Decoster, Paul Germonpré, Elke Govaerts, Stéphane Holbrechts, Marc Lambrechts, Sebahat Ocak, Veerle Surmont, Oswald Van Cutsem, Kristof Cuppens, Liesbet Lodewyckx, Ingel Demedts, Lore Decoster, Benoît Colinet, Koen Deschepper, Annelies Janssens, Daniella Galdermans, Thierry Pieters, REVEAL Study Group, Lynn Decoster, Paul Germonpré, Elke Govaerts, Stéphane Holbrechts, Marc Lambrechts, Sebahat Ocak, Veerle Surmont, Oswald Van Cutsem

Abstract

Background: Treatment of patients with epidermal growth factor receptor-mutated (EGFRm) non-small cell lung cancer (NSCLC) continues to evolve expeditiously.

Objectives: This retrospective study investigated real-world treatment patterns and EGFR mutation testing in patients with EGFRm advanced NSCLC in Belgium.

Methods: Data were extracted from medical records of adults diagnosed with EGFRm locally advanced/metastatic NSCLC between 1 September 2015 and 31 December 2017. Patients were followed retrospectively from diagnosis until 1 September 2018, end of clinical activity or death. Data on demographics, patient outcomes and disease characteristics, treatment patterns and EGFR mutation testing at diagnosis and progression were analyzed descriptively.

Results: A total of 141 patients were enrolled. At diagnosis, median age was 69 years, 63.1% were female, 88.7% had metastatic disease, 94.3% had adenocarcinoma histology, 76.6% had ECOG 0/1, 70.9% had common EGFR mutations and 29.1% had only rare mutations. In first line, 73.8% of patients received first/second-generation EGFR-tyrosine kinase inhibitors (1G/2G EGFR-TKIs), while 21.9% received other systemic treatments. Among 61 patients progressing on and discontinuing a first 1G/2G EGFR-TKI, 45 (73.8%) received subsequent systemic treatment while 16 (26.2%) did not; 20 (32.8%) received osimertinib. Among 65 patients progressing on a first 1G/2G EGFR-TKI, 47 (72.3%) were tested for T790M, of whom 25 (53.2%) were positive.

Conclusion: These real-world data from Belgium show that a substantial fraction of patients with EGFRm NSCLC do not receive 1G/2G EGFR-TKIs in first line and do not receive subsequent systemic treatment after progression on 1G/2G EGFR-TKIs. Only a third receive osimertinib upon progression on 1G/2G EGFR-TKIs. These observations should be considered in first-line treatment decisions.

Trial registration: ClinicalTrials.gov: NCT03761901-December 3, 2018.

Conflict of interest statement

L. Lodewyckx is an employee of AstraZeneca. All other authors and/or their institutions received study fees and/or non-financial support from AstraZeneca during the conduct of the study and for advisory boards. In addition, outside the submitted work, K. Cuppens received personal fees and non-financial support from Bristol-Myers-Squibb, Hoffman-La Roche, Merck-Sharp-Dohme, Pfizer and Boehringer-Ingelheim and personal fees from Merck-Serono; I. Demedts received a grant and personal fees from AstraZeneca; L. Decoster received travel grants from Hoffman-La Roche, Merck-Sharp-Dohme and a study grant from Boehringer-Ingelheim; K. Deschepper received personal fees from AstraZeneca, Hoffman-La Roche, Merck-Sharp-Dohme, Boehringer-Ingelheim and Bristol-Myers-Squibb; D. Galdermans received personal fees from Hoffman-La Roche, Merck-Sharp-Dohme, Boehringer-Ingelheim and Chiesi; A. Janssens received non-financial support from Hoffman-La Roche; B. Colinet received personal fees and non-financial support from Bristol-Myers-Squibb, Hoffman-La Roche, Merck-Sharp-Dohme, Pfizer, Boehringer-Ingelheim and Bayer.

Figures

Fig. 1
Fig. 1
Patient flow diagram. Patients who received best supportive care (no systemic treatment) in 2L or 3L after discontinuing 1L or 2L, respectively, were only reported in the 2L or 3L patient population if they had a T790M test done after progression in 1L or 2L, respectively. aOnly considers progressions on an EGFR-TKI (first/second-generation) if it was the first time the patient progressed on an EGFR-TKI (i.e., a progression in 2L or 3L was only counted if the patient received no prior EGFR-TKI or received a prior EGFR-TKI on which the patient did not progress). 1L first-line treatment, 2L second-line treatment, 3L third-line treatment, AE adverse event, BSC patients receiving best supportive care or no systemic treatment for non-small cell lung cancer, EGFR-TKI epidermal growth factor receptor-tyrosine kinase inhibitor, LTF lost to follow-up, N number of patients in the indicated population/category, Syst patients receiving systemic treatment

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