BACKGROUND: Complete resection +/- adjuvant chemotherapy is recommended for most patients (pts) with early-stage (I–IIIA) NSCLC; however, 5-year overall survival (OS) rates for this regimen decrease with advancing disease stage. Osimertinib is a third-generation, EGFR-tyrosine kinase inhibitor approved as adjuvant tx for resected stage IB–IIIA EGFR mutated (EGFRm) NSCLC, based on the ADAURA trial results. We report final results from a global retrospective chart review of electronic health records (EHRs) for pts with resected stage IA–IIIA NSCLC, to show EGFRm frequency, tx patterns and outcomes prior to osimertinib approval.
METHODS: Adults (≥18 yrs) with completely resected stage IA–IIIA NSCLC with available EGFRm results, who were diagnosed between 01Jan2014–31Dec2017, were assessed from diagnosis (Dx) until last follow-up/death. Primary endpoints included EGFRm frequency, tx patterns and OS. Sites of 1st recurrence was a secondary endpoint.
RESULTS: EHRs were collected from 1243 pts in 8 countries. Of 530 pts (43%) with EGFRm NSCLC (pt characteristics, Table); 251 (47%) received surgery only (88% were stage I), 32 (6%) received surgery + neoadjuvant tx, and 177 (33%) received surgery + adjuvant tx. chemotherapy was the most common adjuvant tx (170 / 177, 95% [n=14 stage IA, 37 stage 1B, 56 stage II, 63 stage III]). After a median follow-up of 58 months (IQR 46–73) median OS was not reached; 5-year OS probability was 78%. Five-year OS probabilities for stages IA / IB / IIA / IIB / IIIA were 94% / 85% / 73% / 76% / 46%. For 113 pts who received (neo)adjuvant tx, the most common sites of 1st recurrence were lung (38%) and brain (28%).
CONCLUSION: In this rw international study of pts with completely resected stage IA–IIIA EGFRm NSCLC, diagnosed between 2014–2017, 5-year landmark OS probabilities decreased from 94% to 46% from stage IA to IIIA. Early Dx and EGFR testing to inform optimal tx may improve outcomes in this population.
