Cancer Res Treat.  2023 Oct;55(4):1152-1170. 10.4143/crt.2023.493.

Final Report on Real-World Effectiveness of Sequential Afatinib and Osimertinib in EGFR-Positive Advanced Non–Small Cell Lung Cancer: Updated Analysis of the RESET Study

• Kim T
• Jang TW
• Choi CM
• Kim MH
• Lee SY
• Chang YS
• Lee KY
• Kim SJ
• Yang SH
• Ryu JS
• Lee JE
• Lee SY
• Park CK
• Lee SH
• Jang SH
• Yoon SH
• Oh HJ

• KMID: 2547790
• DOI: http://doi.org/10.4143/crt.2023.493

Abstract

Purpose
This study aimed to report the final analysis of time-on-treatment (TOT) and overall survival (OS) in patients with advanced-stage epidermal growth factor receptor (EGFR)+ non–small cell lung cancer (NSCLC) who received sequential afatinib and osimertinib and to compare the outcomes with other second-line regimens (comparator group).
Materials and Methods
In this updated report, the existing medical records were reviewed and rechecked. TOT and OS were updated and analyzed according to clinical features using the Kaplan-Meier method and log-rank test. TOT and OS were compared with those of the comparator group, in which most patients received pemetrexed-based treatments. A multivariable Cox proportional hazard model was used to evaluate features that could affect survival outcomes.
Results
The median observation time was 31.0 months. The follow-up period was extended to 20 months. A total of 401 patients who received first-line afatinib were analyzed (166 with T790M+ and second-line osimertinib, and 235 with unproven T790M and other second-line agents). Median TOTs on afatinib and osimertinib were 15.0 months (95% confidence interval [CI], 14.0 to 16.1) and 11.9 months (95% CI, 8.9 to 14.6), respectively. The median OS in the osimertinib group was 54.3 months (95% CI, 46.7 to 61.9), much longer than that in the comparator group. In patients who received osimertinib, the OS was longest with Del19+ (median, 59.1; 95% CI, 48.7 to 69.5).
Conclusion
This is one of the largest real-world studies reporting the encouraging activity of sequential afatinib and osimertinib in Asian patients with EGFR+ NSCLC who acquired the T790M mutation, particularly Del19+.

Keyword

Afatinib; Osimertinib; Real-world effectiveness; Non-small-cell lung carcinoma; ErbB receptors

Figure

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  Fig. 1 Patient selection process. AJCC, American Joint Committee on Cancer; EGFR, epidermal growth factor receptor; NSCLC, non–small cell lung cancer.

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  Fig. 2 Overall survival between osimertinib and other treatments groups.

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  Fig. 3 Overall survival between osimertinib and pemetrexed-containing agents.

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  Fig. 4 Overall survival comparing osimertinib, pemetrexed-platinum doublet, and pemetrexed monotherapy.

Reference

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