Treatment outcomes of non-small cell lung cancers treated with EGFR tyrosine kinase inhibitors: a real-world cohort study

Abstract

Background

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) are a standard of care treatment options in non-small cell lung cancer (NSCLC). The present study investigated real-world EGFR TKI use and patient outcomes in NSCLC.

Material and methods

We collected all the patients who had reimbursement for EGFR TKIs in Finland 2011–2020 and had data available at Finnish Cancer Registry. Survival and time-on-treatment (ToT) were analyzed from the first EGFR TKI purchase and patients were stratified according to the TKIs.

Results

Whole patient cohort consisted of 1498 individuals who were treated with erlotinib (n = 998), afatinib (n = 258), or gefitinib (n = 238). In the EGFR mutant cohort (all gefitinib users and afatinib users with non-squamous histology; n = 466), survival was comparable to registrational trials while patients treated with afatinib had improved survival (HR 0.67 CI 95% 0.53–0.85) and longer ToT (13.9 vs 11.9 months, NS) compared to those treated with gefitinib. Females treated with afatinib had improved survival (HR 0.61 CI 95% 0.44–0.83) and longer ToT (15.1 vs 12.5 months, NS) compared to gefitinib while similar was not observed in males. Later line osimertinib treatment was applied for 78 patients. Approximately 20% of the individuals treated with previous gefitinib or afatinib had later line osimertinib treatment. Efficacy analysis of osimertinib treated showed similar ToT and survival regardless of the first line EGFR TKI.

Conclusions

EGFR mutants treated with afatinib have improved outcomes compared to gefitinib while later-line osimertinib was applied only for around 20% of the individuals. The study further highlights the good real-world performance of EGFR TKIs and sheds light on therapy sequencing.

Keywords:

• EGFR TKIs
• nSCLC
• EGFR mutant
• RWE

Ethics approval and consent to participate

All Data collection was carried out according to national legislation and under a permit from the Findata (THL/6637/14.05.22/2021). Pseudonymization was carried out before data analysis. Informed consent was not required due to the register nature of the study.

Consent for publication

All the authors have read and approved the final version of the manuscript.

Author’s contributions

OM, SI, MA, and JPK designed and coordinated the work. OM, MA, SI, and JPK, carried out statistical analysis. All the authors participated in analysis and interpretation of the data, and drafted, read, and approved the final version of the manuscript.

Disclosure statement

OM reports personal fees from MSD outside the submitted work. LP and MA declare no conflict of interest. SI reports personal fees from MSD, personal fees and grants from Roche, personal fees from BMS, personal fees and grants from AstraZeneca, personal fees from Novartis, personal fees from Takeda, personal fees from Janssen, personal fees from Eisai all outside the submitted work. RK reports consulting, lecture, and advisory board fees from Boehringer Ingelheim, virtual congress costs from Roche and Novartis, an advisory board fee from MSD, outside the submitted work. JPK reports grants and personal fees from Roche, grants and personal fees from AstraZeneca, personal fees from Janssen, personal fees from BMS, personal fees from Merck, personal fees from Amgen, personal fees from Novartis, personal fees from Merck KgA, personal fees from Sanofi all outside the submitted work. JPK is a part-time employee of Faron Pharmaceuticals.

Data availability statement

Owing to data protection legislation in Finland, individual-level data on the study subjects cannot be released.

Additional information

Funding

This work was supported by the University of Oulu, Oulu University Hospital, and Boehringer-Ingelheim. This work was also supported by Oulun Yliopisto;Oulun Yliopistollinen Sairaala.