JTO Clinical and Research Reports (Aug 2024)

Characteristics of Long-Term Survivors With EGFR-Mutant Metastatic NSCLC

  • William Tompkins, MD,
  • Connor B. Grady, MPH,
  • Wei-Ting Hwang, PhD,
  • Krishna Chandrasekhara,
  • Caroline McCoach, MD,
  • Fangdi Sun, MD,
  • Geoffrey Liu, MD,
  • Devalben Patel, MD,
  • Jorge Nieva, MD,
  • Amanda Herrmann, MD,
  • Kristen Marrone, MD,
  • Vincent K. Lam, MD,
  • Vamsi Velcheti, MD,
  • Stephen V. Liu, MD,
  • Gabriela Liliana Bravo Montenegro, MD,
  • Tejas Patil, MD,
  • Jared Weiss, MD,
  • Kelsey Leigh Miller, MD,
  • William Schwartzman, MD,
  • Jonathan E. Dowell, MD,
  • Khvaramze Shaverdashvili, MD,
  • Liza Villaruz, MD,
  • Amanda Cass, PharmD,
  • Wade Iams, MD,
  • Dara Aisner, MD, PhD,
  • Charu Aggarwal, MD,
  • D. Ross Camidge, MD, PhD,
  • Melina E. Marmarelis, MD,
  • Lova Sun, MD

Journal volume & issue
Vol. 5, no. 8
p. 100669

Abstract

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Introduction: Characteristics of long-term survivors in EGFR-mutant (EGFRm) NSCLC are not fully understood. This retrospective analysis evaluated a multi-institution cohort of patients with EGFRm NSCLC treated in the pre-osimertinib era and sought to describe characteristics of long-term survivors. Methods: Clinical characteristics and outcomes were abstracted from the electronic medical records of patients with EGFRm metastatic NSCLC who started first-line therapy before 2015. Demographics and comutations were compared between greater than or equal to 5-year survivors and less than 5-year survivors. Multivariable Cox proportional hazard and logistic regression models were used to evaluate factors associated with survival and the odds of death within 5 years, respectively. Results: Overall, 133 patients were greater than or equal to 5-year survivors; 127 were less than 5-year survivors. Burden of pathogenic comutations including TP53 and PIK3CA was similar between greater than or equal to 5-year survivors and less than 5-year survivors. Receipt of first-line chemotherapy rather than EGFR tyrosine kinase inhibitor was similar between the groups (22% of <5-y versus 31% of ≥5-y). Baseline brain metastasis and history of smoking were associated with higher odds of death within 5 years (odds ratio = 2.16, p = 0.029 and odds ratio = 1.90, p = 0.046, respectively). Among patients without baseline brain metastases, cumulative incidence of brain metastases at 5 years was 42.3%. Both baseline and post-baseline brain metastasis were associated with worse overall survival compared with no brain metastasis (hazard ratio = 3.26, p < 0.001 and hazard ratio = 4.99, p < 0.001, respectively). Conclusions: Within patients treated for EGFRm metastatic NSCLC before 2015, absence of brain metastasis and nonsmoking status were predictive of 5-year survival. Our findings help to define a subset of patients with EGFRm NSCLC with excellent survival outcomes who may not require intensification of initial therapy.

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