First-Line EGFR Inhibition Improves Overall Survival in EGFR–Amplified Gastroesophageal Adenocarcinoma

In the 7 years following the release of Dutch treatment guidelines recommending tyrosine kinase inhibitor (TKI) treatment for patients with activating epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC), overall survival (OS) has almost doubled to 12.4 months among EGFR-positive women younger than 50, according to a population-based study of more than 30,000 patients in the Netherlands Cancer Registry.

“At population level, TKI treatment in patients with non-squamous EGFR-positive, stage IV NSCLC has very strong beneficial effects on outcome…Of the improvement in OS that was made over the years for the whole group, about one-third seems to be attributed to TKI treatment in EGFR-positive patients,” wrote lead author Deirdre ten Berge, MD, Erasmus Medical Center, Rotterdam, and coauthors.

Of the 31,291 patients in the registry, 7% were EGFR-positive, 71% of whom were treated with TKIs. Only first-line treatments were recorded. The follow-up data were complete until February 2021.

Over the study period, OS for the whole group increased by 0.6 months. The highest OS was 23.6 months for EGFR-positive patients younger than 50 who were treated with TKIs. For EGFR-positive patients as a whole, median OS was 15.7 months; according to age, it ranged from 21.5 months in the youngest to 13.6 months in the oldest. In those without an EGFR mutation, OS was 7.2 months for those younger than 50, and 3.5 months for those older than 65.

Of the total cohort, 6% was aged below 50. Being young reduced the hazard of death (hazard rartio [HR], 0.71) irrespective of treatment, while male gender increased it (HR, 1.22). In the EGFR-positive patients, however, risk of death was most strongly inversely associated with the use of TKI (HR, 0.45).

Source:
Ten Berge D, Aarts M, Groen H, et al. A population-based study describing characteristics, survival and the effect of TKI treatment on patients with EGFR mutated stage IV NSCLC in the Netherlands. Eur J Cancer. Published online March 3, 2022. doi:10.1016/j.ejca.2022.01.038.