Follow-up testing, treatment missing after first-line advanced NSCLC EGFR-TKI therapy
medwireNews: US researchers highlight the need for follow-up of stage IV non-small-cell lung cancer (NSCLC) patients who receive first-line EGFR–tyrosine kinase inhibitor (TKI) therapy, finding few patients subsequently undergo testing for the T790M mutation.
Eric Nadler (Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas) and co-workers say data from the US Oncology Network iKnowMedTM electric health records for 2015–2017 show that 98% of 308 EGFR-positive patients received EGFR–TKI therapy, most commonly the first-generation agent erlotinib, but just 26% subsequently received a second-line treatment.
Of the 246 patients given first-line EGFR–TKI without chemotherapy, only 19% were tested for the T790M mutation, a third (34%) of whom were positive for this biomarker.
And only 18% of the first-line EGFR–TKI cohort went on to receive a second-line therapy, most commonly pemetrexed-based chemotherapy (45%), with the second-generation EGFR–TKI afatinib and the third-generation EGFR–TKI osimertinib, which targets the EGFR T790M mutation, given to just 16% of patients each.
Nadler et al report that over a median follow-up of 7.6 months, 20% of the first-line EGFR–TKI cohort continued on their initial treatment, 15% died on or after first-line EGFR–TKI therapy, 12% went onto a second-line treatment, and 53% discontinued EGFR–TKI therapy without any record of further treatment.
“Although multiple generations of EGFR–TKIs are available, after [first-line] EGFR–TKI, the majority of patients may not get subsequent targeted therapy, suggesting the need to understand how to optimize targeted therapy treatment among known EGFR mutation-positive patients,” the team writes in Advances in Therapy.
The authors conclude: “As understanding of resistance mechanisms in mutation-driven NSCLC is rapidly evolving, and as ongoing studies evaluate optimal treatment sequencing, integration of this information into clinical practice will be imperative.”
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