Second‐Line Therapy Following Osimertinib in Metastatic
EGFR
‐Mutated Non‐Small‐Cell Lung Cancer at an Academic Medical Center
Michael Rafizadeh, Stephanie Bogdan, Jonathan Lee, Christine Garcia, Ashish Saxena, Kathy Zhou, Bobak Parang ABSTRACT
Background
FLAURA2 demonstrated that adding chemotherapy to osimertinib improved overall survival compared with osimertinib monotherapy in metastatic epidermal growth factor receptor ‐mutated ( EGFR ‐mut) non‐small‐cell lung cancer (NSCLC). Notably, only 60% of patients in the osimertinib monotherapy arm received second‐line therapy after discontinuing first‐line osimertinib. Aims We hypothesized that a higher proportion of patients on osimertinib monotherapy receive second‐line therapy at academic medical centers in the United States (US).
Methods and Results
This is a retrospective cohort study of 115 patients with metastatic EGFR ‐mut NSCLC treated with first‐line osimertinib monotherapy at an academic medical center in the United States from February 2018 to July 2024. Analyses included Kaplan–Meier survival estimation, log‐rank test, multivariate Cox regression, Wilcoxon rank‐sum test, and Fisher's exact test. Most patients were female (74%) and had a history of never‐smoking (69%); 50% were Asian, and 93% of patients had adenocarcinoma histology. The median time to treatment failure (TTF) for all patients on first‐line osimertinib was 25.3 months (95% CI: 18.6–37.5). The median TTF was 15.7 months (CI: 13.1–22.0) for patients with TP53 ‐mut disease and 42.2 months (CI: 36.9–NR) for patients with TP53 wild‐type tumors (log‐rank test, p < 0.001). Of the 115 total patients, 66 (57.4%) discontinued first‐line osimertinib. Of these 66 patients, 26 (39.4%) either died or pursued hospice. Forty (60.6%) of the 66 patients experienced progression of disease and subsequently received second‐line therapy.
Conclusion
Only 61% of patients with metastatic EGFR ‐mut NSCLC received second‐line therapy after osimertinib at our institution, similar to the second‐line therapy rates in the control arm of FLAURA2.