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- Title
Stepwise prolongation of overall survival from first to third generation EGFR-TKIs for EGFR mutation-positive non-small-cell lung cancer: the Tokushukai REAl-world Data project (TREAD 01).
- Authors
Uryu, Kiyoaki; Imamura, Yoshinori; Shimoyama, Rai; Mase, Takahiro; Fujimura, Yoshiaki; Hayashi, Maki; Ohtaki, Megu; Otani, Keiko; Hibino, Makoto; Horiuchi, Shigeto; Fukui, Tomoya; Fukai, Ryuta; Chihara, Yusuke; Iwase, Akihiko; Yamada, Noriko; Tamura, Yukihiro; Harada, Hiromasa; Shinozaki, Nobuaki; Tsuya, Asuka; Fukuoka, Masahiro
- Abstract
Objective The introduction of new-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has afforded promising overall survival outcomes in clinical trials for non-small-cell lung cancer. We aim to investigate the current adoption rate of these agents and the real-world impact on overall survival among institutions. Methods In a nationwide retrospective cohort study of 46 Tokushukai Medical Group hospitals in Japan, we analyzed clinical data of consecutive patients with non-small-cell lung cancer receiving EGFR-TKIs between April 2010 and March 2020. Univariate and multivariate Cox regression analyses examined the associations between overall survival and patient/tumor-related factors and first-line EGFR-TKIs. Results A total of 758 patients (58.5% females; median age, 73 years) were included. Of 40 patients diagnosed in 2010, 72.5% received gefitinib, whereas 81.3% of 107 patients diagnosed in 2019 received osimertinib as the first-line EGFR-TKI. With a median follow-up of 15.8 months, the median overall survival was 28.4 months (95% confidence interval, 15.3–31.0). In a multivariate Cox regression analysis, age, body mass index, disease status, EGFR mutational status and first-line epidermal growth factor receptor tyrosine kinase inhibitor were identified as significant prognostic factors after adjusting for background factors including study period, hospital volume and hospital type. The estimated 2-year overall survival rates for gefitinib, erlotinib, afatinib and osimertinib were 70.1% (95% confidence interval 59.7–82.4), 67.8% (95% confidence interval 55.3–83.2), 75.5% (95% confidence interval 64.7–88.0) and 90.8% (95% confidence interval 84.8–97.3), respectively. The median time to treatment failure of gefitinib, erlotinib, afatinib and osimertinib were 12.8, 8.8, 12.0 and 16.9 months or more, respectively. Conclusions Our real-world data revealed that the swift and widespread utilization of newer-generation EGFR-TKIs in patients with EGFR mutation-positive non-small-cell lung cancer, and that these newer-generation EGFR-TKIs can prolong overall survival regardless of hospital volume or type. Therefore, osimertinib could be a reasonable first choice treatment for these patients across various clinical practice settings.
- Publication
Japanese Journal of Clinical Oncology, 2024, Vol 54, Issue 3, p319
- ISSN
0368-2811
- Publication type
Article
- DOI
10.1093/jjco/hyad162