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

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

Affiliations

William Tompkins, MD: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corresponding author. Address for correspondence: William Tompkins, MD, Perelman Center for Advanced Medicine, 10th Floor, South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
Connor B. Grady, MPH: Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Wei-Ting Hwang, PhD: Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Krishna Chandrasekhara: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Caroline McCoach, MD: UCSF School of Medicine, University of California San Francisco, San Francisco, California
Fangdi Sun, MD: UCSF School of Medicine, University of California San Francisco, San Francisco, California
Geoffrey Liu, MD: Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Devalben Patel, MD: Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Jorge Nieva, MD: University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California
Amanda Herrmann, MD: University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California
Kristen Marrone, MD: Johns Hopkins University School of Medicine, Baltimore, Maryland
Vincent K. Lam, MD: Johns Hopkins University School of Medicine, Baltimore, Maryland
Vamsi Velcheti, MD: NYU Grossman School of Medicine, New York University, New York, New York
Stephen V. Liu, MD: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
Gabriela Liliana Bravo Montenegro, MD: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
Tejas Patil, MD: University of Colorado Cancer Center, Aurora, Colorado
Jared Weiss, MD: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
Kelsey Leigh Miller, MD: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
William Schwartzman, MD: Harold C Simmons Comprehensive Cancer Center, UT Southwestern, Dallas Texas
Jonathan E. Dowell, MD: Harold C Simmons Comprehensive Cancer Center, UT Southwestern, Dallas Texas
Khvaramze Shaverdashvili, MD: UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
Liza Villaruz, MD: UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
Amanda Cass, PharmD: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Wade Iams, MD: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Dara Aisner, MD, PhD: University of Colorado Cancer Center, Aurora, Colorado
Charu Aggarwal, MD: Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
D. Ross Camidge, MD, PhD: University of Colorado Cancer Center, Aurora, Colorado
Melina E. Marmarelis, MD: Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Lova Sun, MD: Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

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.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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