Background: Tyrosine kinase inhibitors (TKIs) are the standard of care for resectable and metastatic non-small-cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations (EGFRm). We describe the real-world practice of EGFRm testing, prevalence, treatment and outcomes in EGFRm stage III NSCLC from a multi-country, observational study. Methods: The KINDLE study retrospectively captured diagnostic information, treatments and survival outcomes in patients with stage III NSCLC from January 2013 to December 2017. Baseline characteristics and treatments were described and real-world outcomes from initial therapy were analysed using Kaplan–Meier methods. Results: A total of 3151 patients were enrolled across three regions: Asia (n = 1874), Middle East and North Africa (MENA) (n = 1046) and Latin America (LA) (n = 231). Of these, 1114 patients (35%) were tested for EGFRm (46% in Asia, 17% in MENA and 32% in LA) and EGFRm was detected in 32% of tested patients (34.3% in Asia, 20.0% in MENA and 28.4% in LA). In a multi-variate analysis, overall EGFRm patients treated with EGFR-TKI monotherapy as initial treatment, without any irradiation, had twice the risk of dying (hazard ratio: 1.983, 95% confidence interval: 1.079–3.643; p = 0.027) versus any other treatment. Finally, unresectable patients with EGFRm NSCLC who received concurrent chemoradiotherapy (cCRT) as initial therapy had longer overall survival (OS) compared with their counterparts who only received TKI monotherapy without any irradiation (48 months versus 24 months; p < 0.001). Conclusion: The KINDLE study showed that a minority of stage III NSCLC patients were tested for EGFRm. Patients with EGFRm with unresectable NSCLC had similar outcomes from cCRT as initial therapy compared with EGFR wild type with a trend in OS favouring the EGFRm group. Outcomes with EGFR-TKI monotherapy as initial therapy, without any irradiation, were worse. The ongoing LAURA study (NCT03521154) will help define the role of EGFR-TKIs in EGFRm stage III NSCLC treated with cCRT. Trial Registration: NCT03725475.
|Journal||Therapeutic Advances in Medical Oncology|
|Publication status||Published - 2022|
Bibliographical noteFunding Information:
Disclosure: ARJ reports receiving research support from AstraZeneca, Merck Sharp & Dohme, and Pfizer and travel support from Bristol-Myers Squibb and AstraZeneca. DSWT reports having advisory role and serving as consultant for Novartis, Bayer, Boehringer Ingelheim, Celgene, AstraZeneca, Eli Lilly, and Loxo Oncology; receiving travel support and honorarium from Merck, Pfizer, Novartis, Boehringer Ingelheim, Roche, and Takeda Pharmaceuticals; and receiving research funding from Novartis, AstraZeneca, GlaxoSmithKline, Bayer, and Pfizer. RAS reports being on advisory board for Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, Merck, Novartis, Pfizer, Roche, Taiho, Takeda Pharmaceuticals, and Yuhan; and receiving research grant support from AstraZeneca and Boehringer Ingelheim. KP reports receiving research funding from Alkem Laboratories, BDR Pharmaceutics, Biocon, Dr. Reddy’s Laboratories, Fresenius Kabi, Natco Pharma, and Roche. AK reports having employment (full time) in AstraZeneca Pharma India Ltd. RH reports having employment (full time) in AstraZeneca Plc.; and stock ownership for Allogene Therapeutics, AstraZeneca, CStone Pharmaceuticals, GlaxoSmith Kline Plc, Imugene Limited, Innate Pharma, Swedish Orphan Biovitrium AB, Chinook Therapeutics, and Adaptimmune Therapeutics. BCC reports receiving research funding from Novartis, Bayer, AstraZeneca, Mogam Institute, Dong-A ST, Champions Oncology, Janssen, Yuhan, Ono Pharmaceuticals, Dizal Pharma, Merck Sharp & Dohme, AbbVie, Medpacto, GI Innovation, Eli Lilly, Blueprint Medicines, and Interpark Bio Convergence Corp.; having consulting role for Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Bristol-Myers Squibb, Ono Pharmaceuticals, Yuhan, Pfizer, Eli Lilly, Janssen, Takeda, Merck Sharp & Dohme, Janssen, Medpacto, and Blueprint Medicines; having stock ownership for TheraCanVac Inc., Gencurix Inc., Bridgebio Therapeutics, Kanaph Therapeutic Inc., Cyrus Therapeutics, and Interpark Bio Convergence Corp.; being on scientific advisory board for Kanaph Therapeutic Inc., Brigebio Therapeutics, Cyrus Therapeutics, and Guardant Health; serving as board of director for Gencurix Inc. and Interpark Bio Convergence Corp.; having royalty for Champions Oncology; and serving as founder for DAAN Biotherapeutics. HCO declares no conflict of interest.
© The Author(s), 2022.
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