Prolonged progression-free survival on epidermal growth factor receptor-tyrosine kinase inhibitors predicts superior response to atezolizumab-based therapy over chemotherapy in epidermal growth factor receptor-mutated non-small-cell lung cancer following progression

Abstract

Background: Patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations who experience disease progression after treatment with an EGFR-tyrosine kinase inhibitor (EGFR-TKI) often receive subsequent treatment with either platinum-based chemotherapy (Chemo) or a combination regimen of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP). However, whether the efficacy of prior EGFR-TKI treatment influences the outcomes of Chemo or ABCP remains unclear. Materials and methods: Between January 2017 and July 2022, we retrospectively assessed patients with EGFR-mutant NSCLC who received Chemo or ABCP after EGFR-TKIs across 20 institutions. Results: Overall, data of 350 patients with advanced or recurrent EGFR-mutant NSCLC were analyzed. Of these, 262 patients (74.9%) received Chemo, and 88 (25.1%) received ABCP. No significant difference was noted in progression-free survival (PFS) after Chemo between patients who responded to prior EGFR-TKIs for ≥10 months and those who had responded for <10 months (6.1 versus 5.1 months; log-rank test, P = 0.12). In contrast, patients who responded to prior EGFR-TKIs for ≥10 months exhibited a significantly longer PFS to ABCP (8.7 versus 6.7 months; log-rank test, P = 0.002). After propensity score matching, among patients who responded to prior EGFR-TKIs for ≥10 months, the ABCP group had a significantly longer PFS than the Chemo group (8.6 versus 5.3 months; log-rank test, P = 0.008). Conclusion: The efficacy of prior EGFR-TKI treatment in patients with EGFR-mutant NSCLC who experience disease progression could be a predictive marker for ABCP rather than Chemo efficacy.

Keywords

• non-small-cell lung cancer
• EGFR mutation
• immune checkpoint inhibitor
• atezolizumab