Characteristics of Long-Term Survivors With EGFR-Mutant Metastatic NSCLC
oleh: William Tompkins, MD, Connor B. Grady, MPH, Wei-Ting Hwang, PhD, Krishna Chandrasekhara, Caroline McCoach, MD, Fangdi Sun, MD, Geoffrey Liu, MD, Devalben Patel, MD, Jorge Nieva, MD, Amanda Herrmann, MD, Kristen Marrone, MD, Vincent K. Lam, MD, Vamsi Velcheti, MD, Stephen V. Liu, MD, Gabriela Liliana Bravo Montenegro, MD, Tejas Patil, MD, Jared Weiss, MD, Kelsey Leigh Miller, MD, William Schwartzman, MD, Jonathan E. Dowell, MD, Khvaramze Shaverdashvili, MD, Liza Villaruz, MD, Amanda Cass, PharmD, Wade Iams, MD, Dara Aisner, MD, PhD, Charu Aggarwal, MD, D. Ross Camidge, MD, PhD, Melina E. Marmarelis, MD, Lova Sun, MD
| Format: | Article |
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| Diterbitkan: | Elsevier 2024-08-01 |
Deskripsi
Introduction: Characteristics of long-term survivors in EGFR-mutant (EGFRm) NSCLC are not fully understood. This retrospective analysis evaluated a multi-institution cohort of patients with EGFRm NSCLC treated in the pre-osimertinib era and sought to describe characteristics of long-term survivors. Methods: Clinical characteristics and outcomes were abstracted from the electronic medical records of patients with EGFRm metastatic NSCLC who started first-line therapy before 2015. Demographics and comutations were compared between greater than or equal to 5-year survivors and less than 5-year survivors. Multivariable Cox proportional hazard and logistic regression models were used to evaluate factors associated with survival and the odds of death within 5 years, respectively. Results: Overall, 133 patients were greater than or equal to 5-year survivors; 127 were less than 5-year survivors. Burden of pathogenic comutations including TP53 and PIK3CA was similar between greater than or equal to 5-year survivors and less than 5-year survivors. Receipt of first-line chemotherapy rather than EGFR tyrosine kinase inhibitor was similar between the groups (22% of <5-y versus 31% of ≥5-y). Baseline brain metastasis and history of smoking were associated with higher odds of death within 5 years (odds ratio = 2.16, p = 0.029 and odds ratio = 1.90, p = 0.046, respectively). Among patients without baseline brain metastases, cumulative incidence of brain metastases at 5 years was 42.3%. Both baseline and post-baseline brain metastasis were associated with worse overall survival compared with no brain metastasis (hazard ratio = 3.26, p < 0.001 and hazard ratio = 4.99, p < 0.001, respectively). Conclusions: Within patients treated for EGFRm metastatic NSCLC before 2015, absence of brain metastasis and nonsmoking status were predictive of 5-year survival. Our findings help to define a subset of patients with EGFRm NSCLC with excellent survival outcomes who may not require intensification of initial therapy.