Presentation (CTI)

OBJECTIVES: Treatment of metastatic non-small cell lung cancer (mNSCLC) often utilizes targeted therapy or chemotherapy, dependent on molecular profiling. Optimal sequencing remains unclear among patients with EGFR-mutated mNSCLC, posing challenges in clinical decision-making. This study characterizes real-world treatment patterns among community and academic physicians and identifies reasons for treatment transitions, particularly among an EGFR-positive patient subgroup.
METHODS: A proprietary AI and natural language processing platform searched, analyzed, and reviewed the Amplity AnswerY™ real-world database composed of HIPAA-compliant, US-based transcribed physician notes. Patients who had mentioned diagnosis of mNSCLC and EGFR-positive disease from 2020-2025 were included and followed from first-line (1L) through third-line (3L) treatments. Trends in prescribing habits and switching reasons were documented between lines of therapy.
RESULTS: AnswerY identified 17,587 patients with mNSCLC, of which 927 patients were EGFR-positive. The mean age of both cohorts was approximately 68 years and most were White (87.1%/83.9%). In both cohorts, chemotherapy alone and a chemotherapy/immunotherapy combination were the most common 1L choices (42.2%/27.4%). The most common 1L-3L treatment sequence among patients reaching each line was chemotherapy alone/immunotherapy alone/other therapies (42.2%/34.8%/40.1%). Among the EGFR-positive subgroup, the most common 1L-3L treatment sequence was an EGFR-targeted therapy other than osimertinib/osimertinib/other therapies (30.0%/29.1%/32.8%). In the EGFR-positive subgroup, approximately 39.7% of patients did not receive an EGFR-targeted therapy in 1L. Among all patients with mNSCLC and EGFR-positive disease, 1L-2L switching reasons included disease progression (41.2%/30.9%), adverse events (7.3%/9.3%), and planned transition (9.3%/2.0%).
CONCLUSIONS: AnswerY identified that among all patients with mNSCLC, chemotherapy is the most common 1L treatment option. However, among the EGFR-positive subgroup a significant proportion of patients did not receive EGFR-targeted 1L treatment, despite being recommended by current treatment guidelines. These data illustrate a need for increased provider education on guideline-directed care in patients with EGFR-positive mNSCLC and continued investigations into understanding barriers to real-world protocol adherence.