TY - JOUR
T1 - Characteristics of Long-Term Survivors With EGFR-Mutant Metastatic NSCLC
AU - Tompkins, William
AU - Grady, Connor B.
AU - Hwang, Wei Ting
AU - Chandrasekhara, Krishna
AU - McCoach, Caroline
AU - Sun, Fangdi
AU - Liu, Geoffrey
AU - Patel, Devalben
AU - Nieva, Jorge
AU - Herrmann, Amanda
AU - Marrone, Kristen
AU - Lam, Vincent K.
AU - Velcheti, Vamsi
AU - Liu, Stephen V.
AU - Montenegro, Gabriela Liliana Bravo
AU - Patil, Tejas
AU - Weiss, Jared
AU - Miller, Kelsey Leigh
AU - Schwartzman, William
AU - Dowell, Jonathan E.
AU - Shaverdashvili, Khvaramze
AU - Villaruz, Liza
AU - Cass, Amanda
AU - Iams, Wade
AU - Aisner, Dara
AU - Aggarwal, Charu
AU - Camidge, D. Ross
AU - Marmarelis, Melina E.
AU - Sun, Lova
N1 - Publisher Copyright:
© 2024
PY - 2024/8
Y1 - 2024/8
N2 - 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.
AB - 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.
KW - Brain metastasis
KW - EGFR
KW - EGFR TKI
KW - NSCLC
KW - Next-generation sequencing
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U2 - 10.1016/j.jtocrr.2024.100669
DO - 10.1016/j.jtocrr.2024.100669
M3 - Article
C2 - 39157674
AN - SCOPUS:85199491652
SN - 2666-3643
VL - 5
JO - JTO Clinical and Research Reports
JF - JTO Clinical and Research Reports
IS - 8
M1 - 100669
ER -