Lin S, Kahangire DA, Nagar S, Ahn M, Affi R, Agulnik J, Shih J, Hockmair MJ, Tufman A, Debieuvre D, Chow J, Jimenez M, Davis KL, Sandelin M, Veluswamy R. Treatment (tx) patterns and outcomes in resectable early-stage non-small cell lung cancer (NSCLC): A global real-world (rw) study. Poster presented at the European Lung Cancer Congress 2023; March 31, 2023. Copenhagen, Demark.

BACKGROUND: Complete resection +/- adjuvant chemotherapy is recommended for most patients (pts) with early-stage (I–IIIA) NSCLC; however, 5-year overall survival (OS) rates for this regimen decrease with advancing disease stage. Osimertinib is a third-generation, EGFR-tyrosine kinase inhibitor approved as adjuvant tx for resected stage IB–IIIA EGFR mutated (EGFRm) NSCLC, based on the ADAURA trial results. We report final results from a global retrospective chart review of electronic health records (EHRs) for pts with resected stage IA–IIIA NSCLC, to show EGFRm frequency, tx patterns and outcomes prior to osimertinib approval.

METHODS: Adults (≥18 yrs) with completely resected stage IA–IIIA NSCLC with available EGFRm results, who were diagnosed between 01Jan2014–31Dec2017, were assessed from diagnosis (Dx) until last follow-up/death. Primary endpoints included EGFRm frequency, tx patterns and OS. Sites of 1st recurrence was a secondary endpoint.

RESULTS: EHRs were collected from 1243 pts in 8 countries. Of 530 pts (43%) with EGFRm NSCLC (pt characteristics, Table); 251 (47%) received surgery only (88% were stage I), 32 (6%) received surgery + neoadjuvant tx, and 177 (33%) received surgery + adjuvant tx. chemotherapy was the most common adjuvant tx (170 / 177, 95% [n=14 stage IA, 37 stage 1B, 56 stage II, 63 stage III]). After a median follow-up of 58 months (IQR 46–73) median OS was not reached; 5-year OS probability was 78%. Five-year OS probabilities for stages IA / IB / IIA / IIB / IIIA were 94% / 85% / 73% / 76% / 46%. For 113 pts who received (neo)adjuvant tx, the most common sites of 1st recurrence were lung (38%) and brain (28%).

CONCLUSION: In this rw international study of pts with completely resected stage IA–IIIA EGFRm NSCLC, diagnosed between 2014–2017, 5-year landmark OS probabilities decreased from 94% to 46% from stage IA to IIIA. Early Dx and EGFR testing to inform optimal tx may improve outcomes in this population.

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