2024 Asia Conference on Lung Cancer (ACLC) - Poster & ePosters-EP02.24

EP02.24 - Lanlan Pang

Pdf Summary

The study explores the optimal choice of EGFR tyrosine kinase inhibitors (TKIs) for treating advanced non-small cell lung cancer (NSCLC) with the specific EGFR L861Q mutation, particularly considering the presence of brain metastases. Conducted across multiple centers, the research involved analyzing a broad genomic database and a real-world cohort of 207 patients from the Sun Yat-Sen University Cancer Center.<br /><br />Key findings reveal that second-generation TKIs like Afatinib and third-generation TKIs are generally more effective than first-generation TKIs in treating NSCLC with the EGFR L861Q mutation. Specifically, for patients without central nervous system (CNS) metastases, second-generation TKIs resulted in a significantly longer progression-free survival (PFS) compared to other generations (median PFS: 18.2 months vs. 6.0 months for first and 14.1 months for third generations).<br /><br />However, among patients with brain metastases, third-generation TKIs proved superior to both first and second-generation TKIs. The third-generation showed a considerable improvement in brain objective response rate (ORR) and PFS (brain ORR: 33.33%; median PFS: 19.3 months), while pooled first and second-generation TKIs showed no significant improvement (brain ORR: 0.00%, median PFS: 7.9 months). This suggests that third-generation TKIs may be the optimal choice for patients with brain metastasis.<br /><br />The study also examines the prevalence of additional mutations, noting that EGFR p.L861Q stands independently in most cases but can co-occur with EGFR p.G719X mutations and amplify in others, though these co-mutations did not notably affect TKI efficacy.<br /><br />Overall, the research provides crucial insights into tailored treatments for NSCLC with rare EGFR mutations, emphasizing the enhanced effectiveness of third-generation TKIs, particularly for patients with brain metastases.

Keywords

EGFR tyrosine kinase inhibitors

non-small cell lung cancer

NSCLC

EGFR L861Q mutation

brain metastases

second-generation TKIs

third-generation TKIs

progression-free survival

brain objective response rate

Sun Yat-Sen University Cancer Center