Christos Chouaid1, Thomas Filleron2, Didier Debieuvre3, Maurice Pérol4, Nicolas Girard5, Eric Dansin6, Hervé Lena7, Radj Gervais8, Sophie Cousin9, Josiane Otto10, Roland Schott11, David Planchard12, Anne Madroszyk13, Courèche Kaderbhai14, Pascale Dubray-Longeras15, Sandrine Hiret16, Eric Pichon17, Christelle Clément-Duchêne18,19, Gaëlle Chenuc20, Gaëtane Simon21, Lise Bosquet21, Xavier QUantin22. 1. Service de Pneumologie, Pneumology, Intercommunal Hospital, 40 avenue de Verdun, 94010, Créteil, France. Christos.Chouaid@chicreteil.fr. 2. Institut Claudius Regaud, Toulouse, France. 3. GHRMSA, Emile Muller Hospital, Mulhouse, France. 4. Centre Léon Bérard, Lyon, France. 5. Institut Curie, Paris, France. 6. Centre Oscar Lambret, Lille, France. 7. University Hospital, Rennes, France. 8. Centre François Baclesse, Caen, France. 9. Institut Bergonié, Bordeaux, France. 10. Centre Antoine Lacassagne, Nice, France. 11. Institut de Cancérologie Strasbourg Europe ICANS, Strasbourg, France. 12. Gustave Roussy, Villejuif, France. 13. Institut Paoli-Calmettes, Marseille, France. 14. Centre Georges-François Leclerc, Dijon, France. 15. Centre Jean Perrin, Clermont-Ferrand, France. 16. Institut de Cancérologie de l'Ouest, Angers, Nantes, France. 17. University Hospital, Tours, France. 18. Institut de Cancérologie de Lorraine, Nancy, France. 19. Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine, Nancy, France. 20. IQVIA, La Defense, Cedex, France. 21. Real-world Data, Unicancer, Paris, France. 22. Institut Régional du Cancer de Montpellier, Montpellier, France.
Abstract
BACKGROUND: In Europe, few data regarding the characteristics of EGFR exon 20 insertion (20ins) mutations in non-small cell lung cancer (NSCLC) are available. OBJECTIVE: Using a large real-world cohort, we assessed the incidence, characteristics, and outcomes of patients with non-squamous (nsq) NSCLC harboring EGFR exon 20ins. PATIENTS AND METHODS: The Epidemio-Strategy and Medical Economics advanced and metastatic lung cancer data platform including advanced/metastatic nsqNSCLC patients from January 2015 was analyzed (cut-off date: June 30, 2020). Characteristics, epidermal growth factor receptor (EGFR) mutation and other mutations, treatment patterns, and clinical outcomes were assessed for patients harboring EGFR exon 20ins, common EGFR mutations, other EGFR mutations, and wild-type EGFR. Survival parameters were estimated by the Kaplan-Meier method in these four groups. RESULTS: Out of 9435 nsqNSCLC patients tested for EGFR, 1549 (16.4%) had a mutation, including 61 with EGFR exon 20ins (3.9% of all mutated EGFR). These 61 patients had a mean age of 63.6 years, were mostly female (68.9%) and non-smokers (55.7%), with de novo stage IV disease (73.8%) and performance status 0-1 (76.9%). Almost all patients (95.1%) with exon 20ins received systemic therapy (median, three lines). First-line systemic treatments consisted mainly of combination chemotherapy (70.7%), single-agent EGFR tyrosine kinase inhibitors (10.3%), and single-agent immunotherapy (5.2%). After a median follow-up of 25.0 (95% confidence interval [CI] 22.3-32.4) months, the median real-world overall survival was 24.3 (19.1-32.6) months in patients with exon 20ins compared to 35.4 (95% CI 32.6-37.5) in patients with common EGFR mutation (n = 1049) (p = 0.049) and 19.6 (95% CI 18.6-20.5) in patients with wild-type EGFR (n = 7866) (p = 0.2). CONCLUSIONS: This large national study in nsqNSCLC patients confirms that EGFR exon 20ins is a rare condition (0.6%). The prognosis associated with exon 20ins appears to be in line with that of wild-type EGFR, but worse than common EGFR mutations, highlighting the need for advancements for this rare population.
BACKGROUND: In Europe, few data regarding the characteristics of EGFR exon 20 insertion (20ins) mutations in non-small cell lung cancer (NSCLC) are available. OBJECTIVE: Using a large real-world cohort, we assessed the incidence, characteristics, and outcomes of patients with non-squamous (nsq) NSCLC harboring EGFR exon 20ins. PATIENTS AND METHODS: The Epidemio-Strategy and Medical Economics advanced and metastatic lung cancer data platform including advanced/metastatic nsqNSCLC patients from January 2015 was analyzed (cut-off date: June 30, 2020). Characteristics, epidermal growth factor receptor (EGFR) mutation and other mutations, treatment patterns, and clinical outcomes were assessed for patients harboring EGFR exon 20ins, common EGFR mutations, other EGFR mutations, and wild-type EGFR. Survival parameters were estimated by the Kaplan-Meier method in these four groups. RESULTS: Out of 9435 nsqNSCLC patients tested for EGFR, 1549 (16.4%) had a mutation, including 61 with EGFR exon 20ins (3.9% of all mutated EGFR). These 61 patients had a mean age of 63.6 years, were mostly female (68.9%) and non-smokers (55.7%), with de novo stage IV disease (73.8%) and performance status 0-1 (76.9%). Almost all patients (95.1%) with exon 20ins received systemic therapy (median, three lines). First-line systemic treatments consisted mainly of combination chemotherapy (70.7%), single-agent EGFR tyrosine kinase inhibitors (10.3%), and single-agent immunotherapy (5.2%). After a median follow-up of 25.0 (95% confidence interval [CI] 22.3-32.4) months, the median real-world overall survival was 24.3 (19.1-32.6) months in patients with exon 20ins compared to 35.4 (95% CI 32.6-37.5) in patients with common EGFR mutation (n = 1049) (p = 0.049) and 19.6 (95% CI 18.6-20.5) in patients with wild-type EGFR (n = 7866) (p = 0.2). CONCLUSIONS: This large national study in nsqNSCLC patients confirms that EGFR exon 20ins is a rare condition (0.6%). The prognosis associated with exon 20ins appears to be in line with that of wild-type EGFR, but worse than common EGFR mutations, highlighting the need for advancements for this rare population.
Authors: Jiyeon Yun; Soo-Hwan Lee; Seok-Young Kim; Seo-Yoon Jeong; Jae-Hwan Kim; Kyoung-Ho Pyo; Chae-Won Park; Seong Gu Heo; Mi Ran Yun; Sangbin Lim; Sun Min Lim; Min Hee Hong; Hye Ryun Kim; Meena Thayu; Joshua C Curtin; Roland E Knoblauch; Matthew V Lorenzi; Amy Roshak; Byoung Chul Cho Journal: Cancer Discov Date: 2020-05-15 Impact factor: 39.397