After discontinuation of an EGFR tyrosine kinase inhibitor (TKI) and platinum-based chemotherapy, the most common next line of therapy for patients with metastatic non-small cell lung cancer (NSCLC) is immunotherapy, according to a study presented at the National Comprehensive Cancer Network (NCCN) Annual Conference.

“EGFR-TKI inhibitors are established first line treatments for metastatic [NSCLC] harboring an EGFR sensitizing mutation. Upon EGFR-TKI resistance, there is little data to support the standard of care in subsequent lines of therapy,” explained Elizabeth Marrett, MPH, Daiichi Sankyo, Basking Ridge, NJ, and colleagues.

This study aimed to examine the subsequent line of therapy after receipt of EGFR-TKI and platinum-based chemotherapy in metastatic NSCLC.

The IQVIA PharMetrics Plus Database was used to identify adult patients with ≥1 medical claim each for lung cancer and a secondary malignancy between January 2010 and September 2019.

Patients with ≥1 claim for an EGFR-TKI and platinum-based chemotherapy after secondary malignancy diagnosis and who initiated a subsequent line of therapy after discontinuing their first EGFR-TKI and platinum-based chemotherapy regimens after November 2015 were included.

A total of 195 patients were analyzed. The mean time from metastatic NSCLC diagnosis to index date was 21.4 months and the mean time from index date to end of follow-up was 9.5 months. Patients had an average of 2.8 lines of therapy prior to index treatment.

Of the 195 patients, 110 (56.4%) received platinum-based chemotherapy prior to an EGFR-TKI, 80 (41.0%) received an EGFR-TKI prior to platinum-based chemotherapy, and 5 (2.6%) received an EGFR-TKI and platinum-based chemotherapy concurrently.

Median time to treatment discontinuation was 2.8 months. After treatment discontinuation, the most common next line of therapy was immunotherapy (n = 57 [29%]), followed by EGFR-TKI monotherapy (n = 41 [21%]), platinum-based chemotherapy regimens (n = 37 [19%]), non-platinum chemotherapy (n = 25 [12.8%]), EGFR-TKI in combination with chemotherapy (n = 12 [6.2%]), VEGF/VEGFR plus chemotherapy (n = 14 [7.2%]), EGFR-TKI plus VEGF/VEGFR and chemotherapy (n = 1 [.5%]), and other (n = 8 [4.1%]).

The most common EGFR-TKI was afatinib, the most common chemotherapy was pemetrexed, and the most common immunotherapy was nivolumab.

“Among patients with prior EGFR-TKI and [platinum-based chemotherapy treatment], [immunotherapy] monotherapy was the most common next [line of therapy], retreatment with or continuation of EGFR-TKIs was common, and the overall duration of therapy was short,” concluded Ms Marrett and colleagues.

“There is an unmet need for new therapy to address TKI resistance in EGFR mutated NSCLC,” they added.—Janelle Bradley

Marrett E, Kwong WJ, Xie J, et al. Treatment Patterns Among Patients With EGFR Mutated Metastatic NSCLC Who Have Discontinued EGFR-TKI and Platinum-Based Chemotherapy Regimens. Presented at: the virtual 2021 NCCN Annual Conference; March 18-20, 2021. Abstract HSR21-063.