Presentation (CTI)

OBJECTIVES: Targeted therapies have transformed metastatic NSCLC (mNSCLC) treatment and are the preferred first-line (1L) treatment for patients with EGFR mutations (Exon 19 deletion [Ex19del] and Exon 21 L858R substitution [L858R]). This study aims to describe treatment patterns, including immunotherapies, in patients with EGFR-mutated (Ex19del/L858R) mNSCLC.
METHODS: This retrospective cohort study assessed Integra Connect (IC) data, covering around 500 US treatment sites. Eligible patients had documented EGFR mutated (Ex19del/L858R) mNSCLC prior to initiating 1L treatment on/after 01/01/2018, with 1L initiation date as index date. All variables were descriptively summarized.
RESULTS: Among 561 patients, the median age was 71 years; 66% were female, 67% White, and 52% never smoked. Ex19del was reported in 51% of patients and L858R mutation was reported in 49% of patients. 73% of patients had reported next-generation sequencing testing. The mean (median) time from initial mNSCLC diagnosis date to 1L initiation was 2.7 (0.5) months. The mean (median) time from initial EGFR-positive (Ex19del/L858R) test result to 1L initiation was 1.9 (0.2) months.The most common 1L treatments included osimertinib monotherapy (75%) and osimertinib combination therapies (11%). By data cut-off (06/30/2024), 245 patients (44%) had received a second-line therapy (2L). Common 2L treatments included chemotherapy/immunotherapy combinations (20%), osimertinib monotherapy (17%), and immunotherapy monotherapy (10%). Overall, 10% of patients received immunotherapy (as monotherapy or combination) as 1L treatment, while nearly one-third (30%) of those initiating 2L therapy received immunotherapy.
CONCLUSIONS: Despite guidelines recommending targeted therapy over immunotherapy in patients with EGFRm (Ex19del/L858R) mNSCLC, use of inappropriate immunotherapy in both 1L and 2L was common in the real-world, highlighting substantial unmet needs and the need for use of more effective targeted treatments for these patients.