2025 Targeted Therapies of Lung Cancer (TTLC) - Posters-PP01.26 Real-world patterns of care post-first line osimertinib (osi) in Canadian EGFR-mutated patients (pts) with non-small cell lung cancer (NSCLC): implications for targeted therapy + chemo regimens in the post-osi setting

PP01.26 Real-world patterns of care post-first line osimertinib (osi) in Canadian EGFR-mutated patients (pts) with non-small cell lung cancer (NSCLC): implications for targeted therapy + chemo regimens in the post-osi setting

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The retrospective cohort study within the CARMA-BROS framework investigated real-world treatment outcomes for patients with EGFR-mutated, advanced non-small cell lung cancer (NSCLC), focusing on the impact of first-line osimertinib (a third-generation EGFR TKI) and subsequent therapies. Conducted across four Canadian centers and utilizing a nationwide database, the study involved 151 patients diagnosed between December 2014 and December 2021. Statistical analyses assessed overall survival (OS) and real-world progression-free survival (rwPFS) from the transition to second-line therapy.<br /><br />Key findings highlighted the prevailing patterns and effectiveness of treatments following osimertinib. Nearly half of the patients did not receive second-line therapy after disease progression, indicating a significant drop-off potentially due to resistance development or logistical/health barriers. Among patients who did continue with second-line treatments, those enrolled in clinical trials or treated with other targeted therapies showed superior OS compared to those receiving chemotherapy alone. Specifically, OS from the initiation of the first-line osimertinib favored patients moving to other targeted treatments or trials, with median survival reaching 43.2 months, significantly higher than the 20.7 months observed in those who received only chemotherapy (p=0.04). Additionally, the study noted a considerable attrition rate when transitioning to second-line systemic therapies.<br /><br />Baseline demographic analysis revealed a median age of 66.5 years, with most patients being never-smokers. Demographics were in line with known profiles of NSCLC patients harboring EGFR mutations, primarily adenocarcinoma. This study underscores the necessity for strategic innovations in the management of NSCLC post-osimertinib, highlighting the potential benefits of integrated targeted therapies and clinical trials. The data suggest a pressing need to address the post-osimertinib treatment gap, which could significantly enhance patient outcomes.

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Sze Wah Samuel Chan

Keywords

retrospective cohort study

CARMA-BROS framework

EGFR-mutated NSCLC

osimertinib

real-world treatment outcomes

second-line therapy

overall survival

progression-free survival

targeted therapies

clinical trials