WCLC 2025 - Posters & ePosters-P2.10.05 Real-World Efficacy of Second-Line Carboplatin Plus Pemetrexed in EGFR-Mutant NSCLC. an International, Multicentre Analysis

P2.10.05 Real-World Efficacy of Second-Line Carboplatin Plus Pemetrexed in EGFR-Mutant NSCLC. an International, Multicentre Analysis

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This international, multicenter retrospective study evaluated the real-world efficacy and safety of second-line (2L) carboplatin plus pemetrexed chemotherapy in 91 patients with EGFR-mutant advanced non-small cell lung cancer (aNSCLC) following first-line (1L) osimertinib treatment. Conducted across 11 European centers between 2018 and 2023, the primary endpoint was overall response rate (ORR), with progression-free survival (PFS), overall survival (OS), and toxicity as secondary endpoints.<br /><br />The cohort had a median age of 62.5 years; 61.5% were male, and 63.7% were never smokers. EGFR mutation types included exon 19 deletions (52.7%), L858R mutations (36.3%), and uncommon variants (11%). At baseline, 35.3% had an ECOG performance status (PS) of 2, with liver and brain metastases in 35.2% and 28.6% respectively.<br /><br />Among 72 evaluable patients, the ORR was 33.3%, with a median PFS of 5.3 months (95% CI: 4.4–6.1) and a median OS of 9.2 months (95% CI: 7.5–10.8). These outcomes are consistent with previously reported data regarding response and PFS; however, the observed OS was notably shorter, indicating poor long-term prognosis. Grade 3-4 chemotherapy-related adverse events occurred in 24.4% of patients; dose reductions were necessary in 23.1%, and treatment discontinuation due to toxicity occurred in 14.3%.<br /><br />Multivariate Cox regression identified poorer OS associated with male gender (HR 1.84, p=0.034), smoking history (HR 1.82, p=0.032), and ECOG PS 2 vs 0-1 (HR 3.73, p=0.001), while mutation subtype and metastases status were not significant.<br /><br />In conclusion, 2L carboplatin plus pemetrexed after osimertinib shows limited efficacy and substantial toxicity in EGFR-mutant aNSCLC, underscoring the urgent need for improved therapeutic strategies post-osimertinib. The study highlights challenges in the sequential treatment paradigm and the necessity to optimize care beyond osimertinib failure.

Asset Subtitle

Martín Igor Gómez-Randulfe Rodríguez

Meta Tag

Speaker Martín Igor Gómez-Randulfe Rodríguez

Topic Metastatic Non-small Cell Lung Cancer – Cytotoxic Therapy

Keywords

EGFR-mutant non-small cell lung cancer

second-line carboplatin plus pemetrexed

osimertinib treatment

overall response rate

progression-free survival

overall survival

chemotherapy toxicity

multicenter retrospective study

ECOG performance status

treatment resistance